羟考酮抑制老年患者腹腔镜下胆囊切除术瑞芬太尼静脉复合麻醉苏醒期疼痛的半数有效量  

50% effective dose of oxycodone on acute pain after intravenous remifentunil anesthesia in elderly patients undergoing laparoscopic cholecystectomy

作　　者：汪伟[1] 杨磊[1] 郁万友[1] 钱燕宁 

机构地区：[1]南京医科大学附属江宁医院麻醉科,211100 [2]南京医科大学第一附属医院麻醉科,210000

出　　处：《国际麻醉学与复苏杂志》2016年第3期205-207,235,共4页International Journal of Anesthesiology and Resuscitation

摘　　要：目的探讨羟考酮抑制老年患者腹腔镜下胆囊切除术瑞芬太尼静脉复合麻醉苏醒期疼痛的药效学。方法选择拟在全身麻醉下行腹腔镜胆囊切除术患者32例，年龄65—74岁，ASA分级I、Ⅱ级。麻醉诱导：依托咪酯0．3mg／kg，瑞芬太尼采用Minto模型靶控输注（target controlled infusion，TCI），效应室浓度为3．0μg／L。待BIS值在40～45后，静脉注射顺式阿曲库铵O．2mg／kg，5min内完成气管插管行机械通气。术中除瑞芬太尼外，不再追加任何镇痛药物，麻醉维持分别TCI丙泊酚（3．0μg几）、瑞芬太尼（2．5—3．0μg/L）。手术结束时停用丙泊酚、瑞芬太尼。手术结束前5min采用改良序贯法静脉注射羟考酮。拔管后30min测定患者术后VAS评分，VAS评分≥4分为术后急性疼痛。计算羟考酮ED50及其95％可信区间（confidence interval，CI），并记录手术时间、术后拔管时间及恶心、呕吐等副作用。结果羟考酮抑制老年患者腹腔镜下胆囊切除术瑞芬太尼静脉复合麻醉苏醒期疼痛的ED50及其95％C1分别为O．126mg/kg和0．093—0．181mg／kg。32例患者术后有1例发生恶心、呕吐，无其他副作用发生。结论羟考酮（0．126mg／kg）可以抑制半数老年患者腹腔镜下胆囊切除术瑞芬太尼静脉复合麻醉苏醒期的疼痛。Objective To determine the effect of oxycodone on emergence pain after intravenous remifentanil anesthesia in elderly patients with laparoscopic eholecystectomy. Methods Thirty-two ASA I or U patients, aged 65-74 years undergoing laparoseopie eholecysteetomy under general anesthesia were studied. Anesthesia was induced with etomidate 0.3 mg/kg, then administrated remifentanil with the Minto model of target controlled infusion （TCI） to the concentration of 3.0 μg/L. When the numerical value of BIS was 40 to 45 we used cisatracurium 0.2 mg/kg and completed intubation and mechanical ventilation in 5 rain. Besides remifentanil, no other analgesic drugs were added. Anesthesia was maintained with propofol and remifentanil by the model of TCI which were terminated at the end of surgery. Oxycodone was injected 5 rain before the end of surgery by using modified Dixon＇s up-and-down method. VAS scores≥4 was defined as postoperative acute pain. ED50 and 95% confidence interval （CI） of oxycodone on postoperative acute pain were calculated. The time of total operation, extubation after operation and side effects such as nausea and vomiting were recorded. Results ED50 was 0.126 mg/kg. 95%CI was 0.093-0.181 mg/kg. There was only one in thirty-two patients which nausea and vomiting occurred. No other adverse reactions occurred. Conclusions Oxycodone（0.126 mg/kg） can inhibit the acute pain after intravenous remifentanil anesthesia in elderly patients undergoing laparoscopic cholecystectomy.

关 键 词：羟考酮 老年 腹腔镜 瑞芬太尼 麻醉苏醒期 疼痛 

分 类 号：R614[医药卫生—麻醉学]