不同麻醉药物联合应用于老年男性患者经会阴前列腺穿刺活检术:一项单中心、前瞻性、随机对照试验  

Different combinations of anesthetics in transperineal prostate biopsy in elderly men:A prospective,randomized,controlled monocentric trial

作　　者：郭晨东 蒲杰 胡益民 GUO Chen-dong;PU Jie;HU Yi-min(Department of Anesthesiology,The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University,Changzhou,Jiangsu 213003,China;Hospital for Skin Diseases,Institute of Dermatology,Chinese Academy of Medical Sciences and Peking Union Medical College,Nanjing,Jiangsu 210042,China)

机构地区：[1]南京医科大学附属常州市第二人民医院麻醉科,江苏常州213003 [2]中国医学科学院皮肤病医院,江苏南京210042

出　　处：《中华男科学杂志》2024年第10期896-902,共7页National Journal of Andrology

摘　　要：目的:比较不同麻醉药物联合方式用于老年男性患者经会阴前列腺穿刺活检术的临床效果。方法:将纳入试验的132例接受经会阴前列腺穿刺活检术的患者随机分为丙泊酚联合舒芬太尼(PS)组、马唑仑联合舒芬太尼联合(RS)组、丙泊酚联合阿芬太尼(PA)组、瑞马唑仑联合阿芬太尼(RA)组。记录4组患者术中及术后8个时间点平均动脉压(MAP)和心率(HR),4组所需补救镇静情况、术后入麻醉恢复室(PACU)时Richmond躁动-镇静(RASS)评分和PACU停留时间,以及各种不良反应发生情况。结果:132例患者均顺利完成手术,在T3~t2的5个时刻点RA、RS组较PA、PS组对MAP影响更小(P<0.05),在T1~T5的5个时刻点,RA、RS组较PA、PS组对HR影响更小(P<0.05),且RA组较RS组这一效果更明显。诱导时RA、RS组较PA、PS组注射痛发生率更低(P<0.05),且PS组较其余3组的呼吸抑制发生率更高(P=0.013)。RA、RS组入PACU时的RASS评分更高、PACU停留时间更短(P<0.05)。术中体动的发生及需要给与补救药物例数RA、RS组更多(P=0.013),但补救药物量4组无统计学差异。结论:对于行经会阴前列腺穿刺活检术的老年男性患者,在保留自主呼吸情况下接受静脉麻醉时,选择瑞马唑仑联合阿芬太尼的用药方式,能使术中血流动力学更平稳,苏醒更快,围术期不良反应发生率更低,若诱导时辅以小剂量丙泊酚,能有效抑制穿刺针置入时的体动,产生更好的麻醉效果。Objective:To compare the clinical effects of different combinations of anesthetics in transperineal prostate biopsy in elderly male patients.Methods:We randomly divided 132 ≥65-year-old male patients to receive transperineal prostate biopsy under combined intravenous anesthesia with propofol + sufentanil(the PS group),remimazolam + sufentanil(the RS group),propofol + alfentanil(the PA group),or remimazolam + alfentanil(the RA group).We recorded the mean arterial pressure(MAP) and heart rate(HR) of the patients,the required rescue sedation,the Richmond Agitation-Sedation Scale(RASS) scores upon admission into the postanesthesia care unit(PACU) after surgery,the length of stay in the PACU and the incidence of adverse reactions,followed by comparison of the data obtained among the four groups.Results:Operations were successfully completed in all the patients.At 5 moment points from T3 to t2,RA and RS groups had less effect on MAP than PA and PS groups(P < 0.05);at 5 moment points from T1 to T5,RA and RS groups had less effect on HR than PA and PS groups(P<0.05),and this effect was more obvious in RA group than in RS group.During anesthesia-induction,the incidence rate of injection pain was remarkably lower in the RA and RS than in the PA and PS groups(P<0.05),and that of respiratory depression was higher in the PS than in the other three groups(P = 0.013).The RASS scores were significantly higher(P<0.05) and the PACU stay shorter in the RA and RS than in the PA and PS groups(P<0.05).Dramatically more cases of intraoperative body movement and remedial medication requirement were observed in the former than in the latter two groups(P = 0.013),but there was no statistically significant difference in the dose of remedial medication between the four groups of patients(P > 0.05).Conclusion:For elderly male patients undergoing transperineal prostate biopsy under intravenous anesthesia with preservation of spontaneous breathing,the combined use of remimazolam and alfentanil can achieve more stable intraoperative hemodynam

关 键 词：瑞马唑仑 阿芬太尼 药物联合 老年男性 前列腺穿刺活检术 

分 类 号：R697.3[医药卫生—泌尿科学]