内镜下硬化剂治疗乙型肝炎肝硬化并发食管胃底静脉曲张破裂出血患者应用不同剂量羟考酮联合丙泊酚靶控输注麻醉效果研究
Anesthesia of different concentrations of oxycodone and target-controlled infusion of propofol combination in patients with hepatitis B liver cirrhosis and esophageal variceal bleeding undergoing endoscopic sclerotherapy
王红霞 1胥晓倩 1于明帅1
作者信息
- 1. 610051 成都市成都医学院第二附属医院/核工业四一六医院麻醉科
- 折叠
摘要
目的 探讨不同剂量羟考酮联合丙泊酚靶控输注麻醉处理乙型肝炎肝硬化并发食管胃底静脉曲张破裂出血(EVB)患者接受内镜下硬化剂治疗(EIS)的效果.方法 2021 年5 月～2023 年3 月我院诊治的乙型肝炎肝硬化并发EVB患者87 例,被随机分为三组,每组29 例,均接受EIS治疗,分别给予A组、B组和C组羟考酮0.04 mg·kg-1、0.08 mg·kg-1和0.12 mg·kg-1 静脉推注诱导麻醉,再给予丙泊酚靶控输注麻醉.观察给药前(T0)、睫毛反射消失时(T1)、置镜后1 min(T2)、拔镜时(T3)和苏醒时(T4)指标变化.采用Stward评分和视觉模拟疼痛评分(VAS)评估苏醒质量和疼痛程度,采用ELISA法检测血清白细胞介素(IL-6)和肿瘤坏死因子α(TNF-α)水平.结果 在T1、T2 和T3 时,C组丙泊酚效应室剂量分别为(3.0±0.2)μg/mL、(3.5±0.2)μg/mL和(3.1±0.6)μg/mL,显著低于B组[分别为(3.2±0.3)μg/mL、(3.7±0.2)μg/mL和(3.5±0.5)μg/mL,P＜0.05]或A组[分别为(3.5±0.4)μg/mL、(3.9±0.3)μg/mL和(3.8±0.4)μg/mL,P＜0.05];C组丙泊酚用量、苏醒时间和Stward评分分别为(388.3±27.1)mg、(11.8±2.0)min和(4.0±0.9)分,与B组[分别为(420.6±31.5)mg、(9.1±1.3)min和(5.1±0.8)分,P＜0.05]或A组[分别为(458.7±28.7)mg、(8.3±1.6)min和(4.0±0.9)分,P＜0.05]比,差异显著;在术后1h和2h时,C组和B组VAS评分显著低于A组(P＜0.05);在术后6h时,B组血清IL-6 和TNF-α水平分别为(30.5±4.4)pg/mL和(16.3±1.9)pg/mL,显著低于A组[分别为(37.3±5.6)pg/mL和(20.6±2.4)pg/mL,P＜0.05]或C组[分别为(35.9±4.7)pg/mL和(19.1±2.6)pg/mL,P＜0.05];C组恶心呕吐和呼吸抑制发生率分别为27.6%和 20.7%,显著高于A组(分别为 10.3%和 3.5%,P＜0.05)或B组(分别为 3.5%和 0.0%,P＜0.05).结论 在采用EIS治疗EVB患者时,应用中等剂量羟考酮诱导联合丙泊酚麻醉可保证较好的麻醉效果,不良事件少.
Abstract
Objective The aim of this study was to explore the anesthesia of different concentrations of oxycodone and target-controlled infusion of propofol combination in patients with hepatitis B liver cirrhosis(LC)and esophageal variceal bleeding(EVB)undergoing endoscopic sclerotherapy(EIS).Methods 87 patients with hepatitis B viral infection-induced LC and EVB were enrolled in our hospital between May 2021 and March 2023,and all patients underwent EIS.The patients were randomly divided into group A,B and C,receiving oxycodone at doses of 0.04 mg·kg-1,0.08 mg·kg-1 and 0.12 mg·kg-1 for induction of anesthesia,and the combination of target-controlled infusion of propofol was continued.The parameters at immediately after disappearance of eyelash reflection(T1),at 1 min after endoscope placement(T2)and immediately after endoscope removal(T3)were recorded.The postoperative recovery quality and pain were evaluated by Stward's scores and the visual analogue scale(VAS).Serum interleukin(IL-6)and tumor necrosis factor α(TNF-α)levels were detected by ELISA.Results At T1,T2 and T3,the effect compartment concentrations of propofol in group C were(3.0±0.2)μg/mL,(3.5±0.2)μg/mL and(3.1±0.6)μg/mL,all much lower than[(3.2±0.3)μg/mL,(3.7±0.2)μg/mL and(3.5±0.5)μg/mL,P＜0.05]in group B or[(3.5±0.4)μg/mL,(3.9±0.3)μg/mL and(3.8±0.4)μg/mL,P＜0.05]in group A;the dosage of propofol,the awakening time and the Stward's socre in group C(388.3±27.1)mg,(11.8±2.0)min and(4.0±0.9),significantly different as compared to[(420.6±31.5)mg,(9.1±1.3)min and(5.1±0.8),P＜0.05]in group B or[(458.7±28.7)mg,(8.3±1.6)min and(4.0±0.9),P＜0.05]in group A;at 1 hour and 2 hours after EIS,the VAS scores in group C or group B were much lower than in group A(P＜0.05);at6 hours after operation,serum IL-6 and TNF-α levels in group B were(30.5±4.4)pg/mL and(16.3±1.9)pg/mL,both much lower than[(37.3±5.6)pg/mL and(20.6±2.4)pg/mL,P＜0.05]in group A or[(35.9±4.7)pg/mL and(19.1±2.6)pg/mL,P＜0.05]in group C;the incidences of nausea and vomiting,and respiratory depression in group C were27.6%and20.7%,much higher than 10.3%and 3.5%in group A(P＜0.05)or 3.5%and 0.0%in group B(P＜0.05).Conclusion We recommend oxycodone at dose of 0.08 mg·kg-1 for induction of anesthesia,and target-controlled infusion of propofol in patients with EVB during EIS,which might guarantee an relatively good anesthetic effect,and less complications.
关键词
肝硬化/食管胃底静脉曲张破裂出血/内镜下硬化剂治疗/丙泊酚/羟考酮/麻醉Key words
Liver cirrhosis/Esophageal variceal bleeding/Endoscopic sclerotherapy/Propofol/Oxycodone/Anesthesia引用本文复制引用
基金项目
成都市科技局医学科研项目(19PJ210)
出版年
2024
国家科技期刊平台
NSTL
维普
万方数据