摘要
目的观察术前静脉注射酒石酸布托啡诺对鼻内镜手术患者全身麻醉苏醒期躁动(EA)发生的影响。方法选择100例美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级择期行鼻内镜手术的成年患者,随机分为干预组和对照组,每组50例。患者分别于麻醉诱导前(T_0时间点)静脉注射酒石酸布托啡诺20μg/kg或等体积的0.9%氯化钠溶液。以丙泊酚2mg/kg、芬太尼3μg/kg和罗库溴铵0.6mg/kg行全身麻醉诱导气管插管,术中以七氟烷和瑞芬太尼维持麻醉。使用血管活性药物维持患者的血流动力学指标稳定在在基线上下20%以内。患者进入麻醉后监测治疗室(PACU)后,吸氧并监测生命体征。由一位PACU护师采用Riker镇静-躁动评分表(SAS评分)对患者进行评估。SAS≥5分时视为发生EA,间断静脉推注丙泊酚0.5mg/kg直至躁动症状消失。记录患者的麻醉时间、手术时间、晶体液输注量、术中出血量、瑞芬太尼使用量,以及在T_0、插管即刻(T_1)、术毕(T_2)、拔除气管内导管即刻(T_3)、出PACU时(T_4)各时间点的平均动脉压(MAP)和心率;记录患者的术毕自主呼吸恢复时间、术毕语言指令反应时间、术毕拔除气管内导管时间、PACU停留时间;于T_0时间点和术后24h进行QoR-40量表调查;于T_3时间点评估患者的咳嗽评分,在T_3至T_4时间段评估患者的恶心呕吐评分和疼痛评分;计算EA发生率,记录患者丙泊酚的使用次数和剂量。结果两组间的麻醉时间、手术时间、晶体液输注量、术中出血量、瑞芬太尼使用量的差异均无统计学意义(P值均>0.05)。干预组在T_3时间点的MAP和T_1至T_3时间点的心率均显著低于对照组同时间点(P值均<0.01)。干预组术毕语言指令反应时间、术毕拔除气管内导管时间均显著短于对照组(P值均<0.05),疼痛评分、SAS评分均显著低于对照组(P值均<0.01)。两组间的术毕自主呼吸恢复时间、PACU停留时间、咳嗽评分、恶心呕吐评分,以及T_0时间点和术后24h的QoR-40评分的差异均无统计学意义(P值均>0.05)。干预组的EA发生率为26.0%(13/50),显著低于对照组的48.0%(24/50,P<0.05)。干预组的丙泊酚使用次数和剂量均显著少于对照组(P值均<0.01)。结论术前静脉注射酒石酸布托啡诺可显著降低鼻内镜手术患者EA的发生率,不延长患者的拔除气管内导管时间和PACU停留时间,可减少镇静药的用量,且患者的血流动力学更加稳定。
Objective To observe the effect of preoperative intravenous infusion of butorphanol tartrate on the incidence of emergence agitation in patients undergoing endoscopic sinus surgery. Methods A total of 100 patients, American Society of Anesthesiologists （ASA） I or IT , scheduled for elective endoscopic sinus surgery, were enrolled in this study and randomly divided into two groups （n = 50） ; intervention group and control group. Patients were intravenously given butorphanol tartrate （20 μg/kg） or equal volume of 0. 9% sodium chloride solution before anesthesia induction （To）. intravenous injection of propofol 2 mg/kg, fentanyt 3 μg/kg and rocuronium 0. 6 mg/kg were used for tracheal intubation. Sevoflurane and remifentanil were used to maintain anesthesia. Vasoactive agents were used to keep hemodynamic changes within 20% of the baseline. Oxygen inhalation was performed and vital signs were monitored after patients were admitted to postanesthesia care unit （PACU）. Patients were considered to have emergence agitation when Riker sedation-agitation score （SAS）≥5. A single dose of propofol （0.5 mg/kg） was injected after agitation, and was repeated if necessary. The following data were recorded., anesthesia time, operation time, infusion volume, amount of blood loss, amount of remifentanil; mean arterial pressure （MAP） and heart rate （HR） at To, intubation immediately （T1）, at the end of the surgery （T2）, extubation immediately （T3） and out of the PACU （T4）; spontaneous breathing recovery time, language instruction response time, extubation time and PACU stay time; the quality of QoR-40 survey at To and 24 h after surgery; cough scores at T3, nausea and vomiting scores and pain scores between T3 and T4, the incidence of emergence agitation and the usage of propofol. Results There were no significant differences in anesthesia time, operation time, crystoloid solution infusion volume, intraoperative blood loss or remifentanil usage between the two groups （all P〉0.05）. MAP at T3 and HR from T, to T3 in the intervention group were significantly lower than those in the control group （all P〈0.01）. The language instruction response time and extubation time in the intervention group were shorter than those in the control group （both P〈0.05）. Pain scores and SAS scores in the intervention group were significantly lower than those in the control group （both P〈0. 01 ）. No statistical differences were found in the spontaneous breathing recovery time, PAOU stay time, cough scores, nausea and vomiting scores, or QoR-40 scores between the two groups （all P〉0.05）. The incidence rate of emergence agitation was 26.0% （13/50） in the intervention group, which was significantly lower than that in the control group （48.0%, 24/50, P〈0. 05）. Both the average frequency and dose of propofol in the intervention group were significantly lower than those in the control group （both P 〈 0. 01 ）. Conclusion Intravenous injection of butorphanol tartrate can significantly reduce the incidence of emergency agitation and the usage of sedatives, and provide more stable hemodynamics during extubation in patients undergoing endoscopic sinus surgery. Meanwhile, it will not extend the extubation time or PACU stay time.
作者
郑丽
怀晓蓉
顾娟
苏殿三
杨立群
ZHENG Li;HUAI Xiaorong;GU Juan;SU Diansan;YANG Liqun(Department of Anesthesiology,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China)
出处
《上海医学》
CAS
北大核心
2018年第5期293-298,共6页
Shanghai Medical Journal
关键词
麻醉
全身
酒石酸布托啡诺
术后躁动
鼻内镜手术
Anesthesia
general
Butorphanol tartrate
Postoperative agitation
Nasal endoscopic surgery
