摘要
目的分析不同剂量羟考酮复合丙泊酚靶控输注麻醉在胆总管结石患者内镜治疗中的效果。方法180例接受内镜治疗的胆总管结石患者作为研究对象,按照麻醉方法不同分为Ⅰ组、Ⅱ组和Ⅲ组,每组60例。Ⅰ组、Ⅱ组、Ⅲ组患者分别在麻醉诱导前5 min静脉注射0.08、0.10、0.12 mg/kg的羟考酮,同时应用丙泊酚完成靶控输注麻醉。对比三组术中丙泊酚效应室浓度(Ce)水平、血流动力学指标、苏醒时间以及丙泊酚使用量。结果完成诱导后(T1)、进镜时(T2)、进入十二指肠乳头开口时(T3),Ⅰ组患者的丙泊酚Ce分别为(3.54±0.42)、(3.99±0.36)、(3.86±0.28)μg/ml,Ⅱ组分别为(3.28±0.53)、(3.62±0.48)、(3.56±0.33)μg/ml,Ⅲ组分别为(3.22±0.48)、(3.53±0.42)、(3.48±0.31)μg/ml;三组T1~T3时术中丙泊酚Ce水平比较差异具有统计学意义(P<0.05)。T1~T3时,Ⅰ组的丙泊酚Ce水平均高于Ⅱ组和Ⅲ组,差异具有统计学意义(P<0.05);Ⅲ组和Ⅱ组患者的丙泊酚Ce水平比较,差异无统计学意义(P>0.05)。三组入室时(T0)和T1时HR和MAP水平比较差异无统计学意义(P>0.05)。T2及T3时,Ⅰ组患者HR分别为(90.91±6.60)、(90.94±5.33)次/min,Ⅱ组分别为(82.74±5.33)、(84.83±4.61)次/min,Ⅲ组分别为(80.76±6.29)、(82.81±9.44)次/min;T2及T3时,Ⅰ组患者MAP分别为(90.77±8.56)、(88.73±9.56)mm Hg(1 mm Hg=0.133 kPa),Ⅱ组分别为(78.29±9.33)、(73.11±10.37)mm Hg,Ⅲ组分别为(74.71±10.92)、(71.77±10.72)mm Hg;T2及T3时,Ⅰ组患者HR和MAP水平均高于Ⅱ组和Ⅲ组,差异具有统计学意义(P<0.05);Ⅲ组和Ⅱ组患者HR和MAP水平比较,差异无统计学意义(P>0.05)。Ⅲ组患者的丙泊酚用量(344.15±30.25)mg少于Ⅰ组的(462.35±44.29)mg和Ⅱ组的(402.25±32.25)mg,Ⅱ组患者丙泊酚使用量少于Ⅰ组,差异具有统计学意义(P<0.05);Ⅰ组和Ⅱ组患者的苏醒时间分别为(8.34±2.33)、(9.02±1.93)min,短于Ⅲ组的(12.17±5.26)min,差异具有统计学意义(P<0.05);Ⅰ组和Ⅱ组患者的苏醒时间比较,差异无统计学意义(P>0.05)。结论在胆总管结石患者的内镜治疗中,麻醉诱导前5 min为其静脉注射0.10 mg/kg的羟考酮复合丙泊酚把控输注,取得满意的效果,值得进一步推广。
Objective To compare the effect of different doses of oxycodone combined with target controlled infusion of propofol in endoscopic treatment of choledocholithiasis patients.Methods A total of 180 patients with choledocholithiasis who received endoscopic treatment were selected as the research subjects,and were divided into groupⅠ,groupⅡand groupⅢaccording to different anesthesia methods,with 60 cases in each group.Patients in groupsⅠ,Ⅱ,andⅢwere intravenously injected with 0.08,0.10,and 0.12 mg/kg of oxycodone at 5 min before induction of anesthesia,while propofol was used to complete target-controlled infusion anesthesia.The effect-site target concentration(Ce)of propofol intraoperatively,hemodynamic indexes,recovery time and propofol dosage were compared among the three groups.Results After completing induction(T1),at the time of entering the scope(T2),and at the time of entering the opening of the duodenal papilla(T3),the Ce levels of propofol were(3.54±0.42),(3.99±0.36),and(3.86±0.28)μg/ml in groupⅠ,and(3.28±0.53),(3.62±0.48),and(3.56±0.33)μg/ml in groupⅡ,and(3.22±0.48),(3.53±0.42),(3.48±0.31)μg/ml in groupⅢ.The difference in intraoperative propofol Ce levels at T1-T3 among the three groups was statistically significant(P<0.05).At T1-T3,the Ce levels of propofol in groupⅠwere higher than those in groupsⅡandⅢ,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the Ce levels of propofol between groupⅢand groupⅡ(P>0.05).There was no statistically significant difference in HR and MAP levels between the three groups when entering the operation room(T0)and T1(P>0.05).At T2 and T3,the HR levels were(90.91±6.60)and(90.94±5.33)times/min in groupⅠ,(82.74±5.33),(84.83±4.61)times/min in groupⅡ,and(80.76±6.29),(82.81±9.44)times/min in groupⅢ.At T2 and T3,the MAP levels were(90.77±8.56)and(88.73±9.56)mm Hg(1 mm Hg=0.133 kPa)in groupⅠ,(78.29±9.33)and(73.11±10.37)mm Hg in groupⅡ,and(74.71±10.92)and(71.77±10.72)mm Hg in groupⅢ.At T2 and T3,the HR and MAP levels of groupⅠwere higher than those of groupⅡand groupⅢ,and the difference was statistically significant(P<0.05).There was no statistically significant difference in HR and MAP levels between groupⅢand groupⅡ(P>0.05).The dosage of propofol(344.15±30.25)mg in groupⅢwas less than(462.35±44.29)mg in groupⅠand(402.25±32.25)mg in groupⅡ,and the dosage of propofol in groupⅡwas less than that in groupⅠ.All the differences were statistically significant(P<0.05).The recovery time in groupⅠand groupⅡwere(8.34±2.33)and(9.02±1.93)min,which was shorter than(12.17±5.26)min in groupⅢ,and the difference was statistically significant(P<0.05).There was no statistically significant difference in recovery time between groupⅠand groupⅡ(P>0.05).Conclusion In endoscopic treatment of patients with choledocholithiasis,target controlled infusion of oxycodone combined with propofol at an intravenous dosage of 0.10 mg/kg 5 min before anesthesia induction can achieve satisfactory results,and this method is worthy of further promotion.
作者
黄海涛
HUANG Hai-tao(People's Hospital of Dadong District,Shenyang 110044,China)
出处
《中国现代药物应用》
2022年第8期99-101,共3页
Chinese Journal of Modern Drug Application
关键词
丙泊酚
羟考酮
胆总管结石
内镜治疗
靶控输注
麻醉
Propofol
Oxycodone
Choledocholithiasis
Endoscopic treatment
Target controlled infusion
Anesthesia
