通讯作者: 刘涛, hzyylt@163.com

DOI：10.12201/bmr.202411.00014

• 摘要：目的 探讨无阿片药物麻醉对经尿道前列腺电切术苏醒期躁动(EA)发生情况的影响。 方法 采用单中心随机对照的研究设计方案,纳入美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级、年龄18~80岁行择期经尿道前列腺电切术的患者78例,采用随机数字表法分为两组(每组39例):常规组(F组)和无阿片组(LY组)。麻醉诱导方案F组采用芬太尼(3 μg/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30min内采用Ramsay镇静量表每5min评估1次EA发生情况、采用VAS评分法每5min评估一次疼痛情况,并记录评分；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6 min(T3 )、插入喉罩后9min(T4 )时的平均动脉压(MAP)及心率；记录补救镇痛情况、手术时间、苏醒时间及PACU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组比较,FY组术后EA发生率、最高VAS评分、拔管时间较低(P<0.05),FY组最高Ramsy评分大于F组(P>0.05)。两组补救镇痛率、手术时间及不良反应发生率差异无统计学意义(均 P> 0.05)。两组心率时间效应、时间与组别交互效应差异均具有统计学意义(P<0.05)；MAP的时间效应、时间与组别的交互效应差异均具有有统计学意义(P<0.05)。两组间各时间点心率比较T1-T4时间点差异具有统计学意义(P<0.05),对照组各时间点心率无差异(P>0.05),试验组T1-T2与T0比较心率上升(P<0.05),其余各时间点比较无差异。两组间平均压比较T1-T4时间点差异具有统计学意义(P<0.05),对照组T0-T5时间平均压依次下降,均达到显著水平(P<0.05),试验组T2-T4与T0比较平均压下降(P<0.05),其余各时间点比较无差异

  关键词： 无阿片麻醉; 前列腺电切 苏醒期躁动; 艾司氯胺酮 右美托咪定; 

   

  Abstract: Objective: To explore the impact of non-opioid anesthesia on the occurrence of emergence agitation (EA) during the recovery period after transurethral resection of the prostate (TURP).Methods: A single-center randomized controlled study design was employed, including 78 patients classified as American Society of Anesthesiologists (ASA) I or II, aged 18 to 80 years, undergoing elective TURP. Patients were randomly divided into two groups of 39: the conventional group (F group) and the non-opioid group (LY group). The anesthesia induction regimen for the F group included fentanyl (3 μg/kg) + propofol (2 mg/kg), while the LY group received esketamine (0.3 mg/kg) + propofol (2 mg/kg). EA was assessed every 5 minutes for 30 minutes following the removal of the laryngeal mask using the Ramsay sedation scale. Pain was evaluated with the VAS scoring method. Mean arterial pressure (MAP) and heart rate were recorded at admission (T0), immediately after laryngeal mask insertion (T1), 3 minutes after insertion (T2), 6 minutes after insertion (T3), and 9 minutes after insertion (T4). Data on rescue analgesia, surgical duration, recovery time, and the occurrence of adverse reactions such as agitation, nausea and vomiting, hypoxemia, nightmares, and hallucinations during PACU recovery were also recorded.Results: Compared to the F group, the LY group had a lower incidence of postoperative EA, maximum VAS score, and extubation time (P<0.05), while the maximum Ramsay score in the LY group was higher than that in the F group (P>0.05). No statistically significant differences were observed in rescue analgesia rates, surgical duration, or adverse reaction rates between the two groups (all P>0.05). The time effect of heart rate and the interaction effect of time and group were statistically significant (P<0.05); the time effect of MAP and the interaction effect of time and group were also statistically significant (P<0.05). The heart rate differences between T1-T4 were statistically significant (P<0.05), with no differences in the control group at each time point (P>0.05). In the experimental group, heart rate increased from T1-T2 compared to T0 (P<0.05), with no differences at other time points. The average pressure differences between T1-T4 were statistically significant (P<0.05), with the control group showing a significant decrease in average pressure from T0-T5 (P<0.05). The experimental group showed a decrease in average pressure from T2-T4 compared to T0 (P<0.05), with no differences at other time points.Conclusion: The non-opioid anesthesia regimen reduces the incidence of EA and postoperative pain scores in TURP patients, without increasing adverse reactions during recovery.

  Key words: Non-opioid; anesthesia, prostate; resection, emergence; agitation, esketamine, dexmedetomidine.

  提交时间：2024-11-08

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• 序号	提交日期	编号	操作
  1	2024-09-16	bmr.202411.00014V1	下载

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