目的 探讨无阿片类药物麻醉对经尿道前列腺电切术(transurethral resection of prostate,TURP)苏醒期躁动(emergence agitation,EA)的影响.方法 选取2023年5月至2024年6月湖州市第一人民医院行TURP患者78例作为研究对象,采用随机数字表法分为F组和LY组,每组39例.F组采用芬太尼(3μg/kg)+丙泊酚(2mg/kg),LY组采用艾司氯胺酮(0.3 mg/kg)+丙泊酚(2mg/kg).喉罩拔除后每5min评估1次EA发生情况、同时采用视觉模拟评分法(visual analog score,VAS)评估疼痛情况.记录入室(T0)、插入喉罩即刻(T1)、插入喉罩后3 min(T2)、插入喉罩后 6min(T3)、插入喉罩后 9min(T4)时的平均动脉压(mean arterial pressure,MAP)及心率(heart rate,HR),补救镇痛情况、手术时间、苏醒时间及复苏期间躁动、恶心、呕吐、低氧血症、噩梦、幻觉等不良反应发生情况.结果 与F组患者比较,LY组术后EA发生率、最高VAS评分、拔管时间较低(P＜0.05),LY组患者的最高镇静评分大于F组(P＜0.05).两组患者各时间点的HR、MAP比较差异有统计学意义(P＜0.05).结论 无阿片类药物麻醉方案在经尿道前列腺电切术中可降低患者苏醒期EA的发生率和术后疼痛评分,且不提高苏醒期不良反应发生率.
Impact of opioid-free anesthesia on the recovery of patients during the awakening phase after transurethral resection of the prostate
Objective To investigate how opioid-free anesthesia affects the occurrence of emergence agitation(EA)during recovery after transurethral resection of prostate(TURP).Methods A total of 78 patients undergoing TURP from May 2023 to June 2024 in the First People's Hospital of Huzhou were selected as the study subjects.Patients were assigned to two groups using a random number table method,group F received fentanyl(3μg/kg)+propofol(2mg/kg),and group LY received esketamine(0.3mg/kg)+propofol(2mg/kg),39 cases in each group.EA was assessed every 5 minutes following the removal of the laryngeal mask,and pain levels were measured using the visual analog score(VAS).Mean arterial pressure(MAP)and heart rate(HR)were recorded at admission(T0),immediately after laryngeal mask insertion(T1),3 minutes after(T2),6 minutes after(T3),and 9 minutes after(T4).Data on rescue analgesia,operation time,recovery time,and adverse reactions during recovery,such as agitation,nausea,vomiting,hypoxemia,nightmares,and hallucinations were also recorded.Results Compared to group F,incidence of postoperative EA,highest VAS score,and extubation time in group LY were lower(P＜0.05).The highest sedation score in group LY was greater than that in group F(P＜0.05).The comparison of HR and MAP at each time point between two groups showed statistically significant differences from T1 to T4(P＜0.05).Conclusion The opioid-free anesthesia regimen reduces incidence of EA and postoperative pain scores in TURP patients without increasing adverse reactions during recovery.
Opioid-free anesthesiaResection of prostateEmergence agitation
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