羟考酮对骨科高龄患者七氟烷复合麻醉后苏醒期躁动的影响

摘要

目的 观察羟考酮对骨科高龄患者七氟烷复合麻醉后苏醒期躁动的影响.方法 采用随机数字表法将在七氟烷复合麻醉下行手术治疗的骨科高龄患者90例分为对照组、舒芬太尼组和羟考酮组,每组30例.手术结束前45 min,羟考酮组给予静脉注射盐酸羟考酮0.1 mg/kg,舒芬太尼组给予静脉注射舒芬太尼0.2 μg/kg,对照组给予静脉注射与羟考酮组等量生理盐水.记录并对比三组患者麻醉前后平均动脉压(MAP)、HR、脉搏血氧浓度(SPO2)、自主呼吸恢复时间、睁眼时间、拔管时间、Riker镇静-躁动评分和疼痛视觉模拟评分(VAS)的变化情况以及不良反应发生情况.结果 舒芬太尼组的自主呼吸恢复时间、睁眼时间、拔管时间均长于对照组及羟考酮组(P<0.05);三组术后MAP、HR和SPO2差异均无统计学意义(均P>0.05);羟考酮组术后Riker镇静-躁动评分降低的程度优于舒芬太尼组和对照组(P<0.05);羟考酮组术后VAS评分降低的程度优于对照组(P<0.05);三组间恶心、呕吐和呼吸抑制发生率比较差异无统计意义(P>0.05).结论 于手术结束前45 min静脉注射0.1 mg/kg盐酸羟考酮,可在不增加副作用的前提下抑制高龄患者七氟烷复合麻醉后苏醒期躁动.%Objective To explore the effect of oxycodone on the emergence agitation in elderly orthopedic patients after sevoflurane-based combined anesthesia.Methods A total of 90 elderly patients undergoing orthopedic operation after sevoflurane-based combined anesthesia were divided into control group(n=30),sufentanil group(n=30) and oxycodone group(n=30) using random number table.At 45 minutes before the end of operation,the oxycodone group,sufentanil group and control group received intravenous injection of oxycodone hydrochloride(0.1 mg/kg),of sufentanil(0.2 μg/kg) and of normal saline(the volume as that in the oxycodone group) respectively.The mean arterial pressure(MAP),HR,oxygen saturation(SPO2),recovery time for spontaneous breathing,time for opening eyes and extubation,Riker Sedation-Agitation Scale score,Visual Analogue Scale(VAS) score and incidence of adverse reactions of the three groups were recorded and compared.Results The recovery time for spontaneous breathing,time for opening eyes and extubation in the sufentanil group were longer than those in the control group and oxycodone group(P<0.05).After operation,there was no significant differences in MAP,HR or SPO2 among the three groups(all P>0.05);the decrease of Riker Sedation-Agitation Scale score in the oxycodone group was superior to that in the sufentanil group or control group(P<0.05);and the decrease of VAS score in the oxycodone group was superior to that in the control group(P<0.05).There were no significant differences in the incidence rate of nausea,vomiting or respiratory depression among the three groups(P>0.05).Conclusion Intravenous injecting with oxycodone(0.1 mg/kg) performed at 45 minutes before the end of operation can inhibit emergence agitation in elderly patients undergoing orthopedic operation after sevoflurane-based combined anesthesia,without increasing the incidence of adverse reactions.