间苯三酚复合羟考酮优化依托咪酯用于老年患者宫腔镜检查的麻醉效果
| 作者: |
1王超,
1刘蕊,
2王秋菊,
1王春光
1 保定市第一中心医院麻醉科，河北 保定 071000 2 保定市第一中心医院 妇产科，河北 保定 071000 |
| 通讯: |
王春光
Email: wangchunguang@163.com |
| DOI: | 10.3978/j.issn.2095-6959.2020.11.016 |
| 基金: | 保定市科技计划项目(1941ZF037)。 |
摘要
目的：观察间苯三酚复合羟考酮优化依托咪酯在老年患者宫腔镜检查中的麻醉效果。方法：选择2018年8月至2019年1月于我院行无痛宫腔镜检查的患者90例，美国麻醉医师协会(ASA)分级II~III级，年龄65~76岁，体重48~63 kg，随机分为3组(每组n=30)：间苯三酚+羟考酮组(P组)、羟考酮组(O组)及对照组(C组)。宫腔镜检查前15 min，P组静脉注射间苯三酚80 mg，O组、C组静脉注射5%葡萄糖溶液20 mL。宫腔镜检查前5 min，P组、O组静脉注射间羟考酮，C组静脉注射0.9%氯化钠注射5 mL。3组患者均静脉注射依托咪酯。术中出现皱眉或体动反应时，静脉追加依托咪酯0.1 mg/kg。记录患者入室(T0)、注射间苯三酚或5%葡萄糖溶液后10 min(T1)、15 min(T2)，诱导后2 min(T3)，进镜后1 min(T4)及5 min(T5)各时间点的生命体征。记录检查过程中皱眉或体动例数及依托咪酯的用量；记录宫腔镜检查时间及苏醒时间；记录低氧血症、头晕、恶心呕吐、肌阵挛等不良反应发生情况。结果：P组检查时间[(11.3±1.5) min]较O组[(15.1±2.6) min]、C组[(16.2±2.2) min]缩短(P<0.05)；P组苏醒时间[(4.3±1.1) vs (7.9±2.3) min]较C组缩短(P<0.05)；P组依托咪酯用量[(11.2±1.7) mg]较O组[(16.4±2.3) mg]、C组[(28.6±2.1) mg]减少(P<0.05)；P组皱眉或体动发生率[2 (7%)]较O组[9 (30%)]、C组[17 (56%)]降低(P<0.05)；P组恶心呕吐[3 (10%) vs 12 (40%)]及肌阵挛[1 (3%) vs 10 (33%)]发生率较C组降低(P<0.05)。P组所有时点(T0~T5)MAP和HR差异无统计学意义(P>0.05)，但C组、O组T4，T5时点MAP和HR较T0时点升高(P<0.05)；P组T4时点MAP[(91.6±4.2) mmHg]和HR[(60.8±3.4)/min]较O组[(103.3±6.8) mmHg，(72.4±4.9)/min]、C组[(121.6±7.4) mmHg，(88.9±6.4)/min]降低(P<0.05)；P组T5时点MAP[(91.3±4.7) mmHg]和HR[(61.5±3.2)/min]较O组[(101.4±3.8) mmHg，(72.6±4.3)/min]、C组[(120.7±6.1) mmHg，(89.3±4.2)/min]降低(P<0.05)。结论：间苯三酚复合羟考酮可优化依托咪酯用于老年患者宫腔镜检查的麻醉效果，不但可以减少依托咪酯用量及不良反应的发生，还可以使血流动力学更加平稳。
关键词：
间苯三酚；羟考酮；依托咪酯；宫腔镜；老年
Optimization for anesthetic effect on etomidate of phloroglucinol combined with oxycodone in elderly patients undergoing hysteroscopy
CorrespondingAuthor: WANG Chunguang Email: wangchunguang@163.com
DOI: 10.3978/j.issn.2095-6959.2020.11.016
Foundation: This work was supported by Plan for Science and Technology of Baoding, China (1941ZF037).
Abstract
Objective: To observe the optimization for anesthetic effect on etomidate of phloroglucinol combined with oxycodone in elderly patients undergoing hysteroscopy. Methods: From August 2018 to January 2019, 90 patients underwent hysteroscopy in the First Center Hospital of Baoding were included in this study. The patients with ASA II–III and aged 65–76 years, weighing 48–63 kg, were divided into three groups (30 cases in each group): phloroglucinol + oxycodone group (group P), oxycodone group (group O) and control group (group C). At 15 min before hysteroscopy, patients were intravenously injected with phloroglucinol (80 mg) in group P and 5% glucose solution (20 mL) in group O and group C. At 5 min before hysteroscopy, patients were intravenously injected with oxycodone (0.06 mg/kg) in group P and group O and 0.9% sodium chloride solution (5 mL) in and Group C. And then, all patients were intravenously injected with etomidate. When frown or body movement occurred during hysteroscopy, etomidate (0.1 mg/kg) was intravenously injected additionally. The MAP, HR and SpO2 was recorded when patients entered the operating room, at 10 and 15 min after the injection of phloroglucinol or 5% glucose solution, at 2 min after induction and 1 and 5 min after hysteroscopy. The occurrence of frown or body movement and dosage of propofol, time of hysteroscopy and waking, the occurrence of respiratory depression, dizziness, nausea and vomiting and myoclonus were recorded. Results: The duration of hysteroscopy was significantly shorter in group P [(11.3±1.5) min] than that of group O [(15.1±2.6) min] and group C [(16.2±2.2) min] (P<0.05), and the waking time in group P was also shorter than that of group C [(4.3±1.1) vs (7.9±2.3) min, P<0.05]. The dosage of etomidate decreased significantly in group P [(11.2±1.7) mg] than that of group O [(16.4±2.3) mg] and group C [(28.6±2.1) mg] (P<0.05). The incidence of frown or body movement was lower in group P [2 (7%)] than that in group O [9 (30%)] and group C [17 (56%)] (P<0.05), and the incidence of nausea and vomiting [3 (10%) vs 12 (40%)] and myoclonus [1 (3%) vs 10 (33%)] was lower in group P than that of group C (P<0.05). There was no significant difference in MAP and HR at all time points in group P (P>0.05), however, MAP and HR at T4 and T5 in group C and group O was significantly higher than those at T0 (P<0.05). Compared with group O and group C, MAP and HR at T4 was significantly lower in group P [(91.6±4.2) vs (103.3±6.8) and (121.6±7.4) mmHg; (60.8±3.4) vs (72.4±4.9) and (88.9±6.4)/min, all P<0.05], and they were also significantly lower at T5 [(91.3±4.7) vs (101.4±3.8) mmHg and (120.7±6.1) mmHg; (61.5±3.2) vs (72.6±4.3) and (89.3±4.2)/min, all P<0.05]. Conclusion: Phloroglucinol combined with oxycodone can optimize the anesthetic effect for hysteroscopy in elderly patients. For it can not only reduce the dosage of etomidate and the occurrence of adverse reactions, but also make the hemodynamics more stable.
Keywords：
phloroglucinol; oxycodone; etomidate; hysteroscopy; elderly