摘要
目的比较羟考酮与舒芬太尼在保留自主呼吸胸腔镜肺大泡切除术中的效果。方法选择2018年1月至2019年12月,根据实验样本量计算,择期行胸腔镜肺大泡切除术的患者50例,其中男性28例,女性22例;年龄18~35岁,平均(26.3±4.7)岁。采用随机数字表法随机分成羟考酮组(O组)和舒芬太尼组(S组),每组25例。两组患者均在胸段椎旁阻滞后静脉诱导置入喉罩保留自主呼吸。麻醉诱导:予右美托咪定1μg/kg泵注,丙泊酚4μg/mL靶控输注(TCI)O组予0.2 mg/kg羟考酮静脉推注,S组予0.2μg/kg舒芬太尼静脉推注。术中维持:丙泊酚2μg/mL TCI靶控输注,吸入1%七氟醚。记录入室时(T_(0))、喉罩放置后15 min、30 min(T_(1)、T_(2))、术后30 min(T_(3))二氧化碳分压(PaCO_(2))、氧分压(PaO_(2))和PH值,计算两组患者术中时间加权的自主呼吸潮气量(TWA-VT)、呼吸频率(TWA-f)、氧饱和度(TWA-SpO_(2))和呼气末二氧化碳分压(TWA-P_(ET)CO_(2));记录患者术中呛咳、术后24 h内恶心呕吐等不良反应情况。结果(1)与S组比较,O组患者在T_(1)、T_(2)时PH和PaO_(2)值升高,PaCO_(2)降低(P<0.05)。(2)与S组比较,O组患者术中的TWA-V_(T)和TWA-f升高,TWA-P_(ET)CO_(2)下降(P<0.05)。(3)O组患者术中及术后不良反应发生率低于S组患者(P<0.05)。结论在保留自主呼吸胸腔镜肺大泡切除术中,与舒芬太尼比较,羟考酮能够优化围术期呼吸管理,且术中及术后不良反应发生率低。
Objective To compare the efficacies of oxycodone and sufentanil administrated in non-intubation thoracoscopic surgery.Methods A total of 50 patients including 28 males and 22 females undergoing non-intubation thoracoscopic surgery were randomly divided into two groups with 25 patients in each group,the age ranged from 18 to 35 years old,and the average age was(26.3±4.7)years old.After performing the thoracic paravertebral nerve block(T4、T5),the patients were induced with dexmedetomidine(1μg/kg)and propofol(4μg/mL TCI),and then 0.2 mg/kg oxycodone and 0.2μg/kg sufentanil were administrated respectively in group O and S.The anesthesia was maintained with propofol and sevoflurane and all patients were kept spontaneous breathing with the aid of LMA mask.During the process of surgery,the results of blood gas analysis were recorded respectively at the moment of in operating room(T0),15min,30min after Laryngeal mask ventilation(T_(1)、T_(2)),30min after surgery(T_(3)).The time-weighted average VT,f,SpO_(2) and P_(ET)CO_(2) were calculated.In addition,the intraoperative cough and Nausea and vomiting 24h after surgery were recorded.Results(1)Compared with that of the patients in group S,the PH,PaO_(2) in group O were risen at T_(1) and T_(2),while the PaCO_(2) were reduced(P<0.05).(2)Compared with that of the patients in group S,the TWA-VT and TWA-f in group O were increased,while the TWA-P_(ET)CO_(2) were decreased(P<0.05).(3)The intraoperative and postoperative incidence of adverse reactions in group O were less than that of patients in group S(P<0.05).Conclusions For the patients undergoing non-intubation thoracoscopic surgery,oxycodone can optimize intraoperative respiratory management and ameliorate the intraoperative and postoperative incidence of adverse reactions.
作者
胡义凤
汪陈豪
吴周全
Hu Yifeng;Wang Chenhao;Wu Zhouquan(Department of Anesthesiology,Nanjing Medical University Affiliated Wuxi Second Hospital Wuxi,Wuxi 214002,China;Nanjing Medical University Affiliated Changzhou NO.2 people’hospital Changzhou,Changzhou 213003,China)
出处
《中华卫生应急电子杂志》
2021年第6期349-352,共4页
Chinese Journal of Hygiene Rescue(Electronic Edition)
基金
江苏省青年卫生人才项目(QNRC2016273)。
关键词
羟考酮
舒芬太尼
自主呼吸
胸腔镜手术
Oxycodone
Sufentanil
Spontaneous breathing
Thoracoscopic surgery
