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目的观察盐酸羟考酮对老年食道癌根治术患者全麻苏醒期谵妄的预防效果。方法选取湖州市中心医院自2014年6月—2015年6月择期静吸复合全身麻醉下行右侧卧位胸腔镜下食道癌根治术患者60例,ASAⅠ~Ⅲ级,年龄≥60岁。采用随机数字表法,将患者分为羟考酮组(O组,30例)和舒芬太尼组(S组,30例),所有患者采用左侧双腔支气管导管行右侧肺单肺通气。手术结束前15 min,给2组患者分别静注盐酸羟考酮0.07mg/kg和等容舒芬太尼0.15μg/kg。记录手术时间、单肺通气时间、术中出血量、尿量、液体输注量及种类;记录睁眼时间、呼吸恢复时间、拔管时间;术前1 d和术后苏醒期采用ICU谵妄评估法进行谵妄状态评定;记录进入麻醉后监测治疗室(PACU)即刻、5、15、30、50、60 min时视觉模拟评分(VAS)、Riker镇静躁动评分(SAS)及不良反应(恶心、呕吐、嗜睡、呼吸抑制)发生情况。结果与S组比较,O组患者睁眼时间、呼吸恢复时间、拔管时间显著缩短(P<0.05);术后谵妄发生率、嗜睡发生人数显著降低(P<0.05);各监测时间点VAS及Riker镇静躁动评分显著降低(P<0.05)。结论手术结束前15 min静注盐酸羟考酮可以预防老年食道癌根治术患者全麻苏醒期谵妄的发生。
Objective To observe the preventive effect of oxycodone hydrochloride on the recovery of delirium in elderly patients with esophageal cancer undergoing general anesthesia. Methods From June 2014 to June 2015, Huazhong Central Hospital underwent selective transthoracic combined general anesthesia for 60 patients undergoing thoracoscopic thoracoscopic esophageal cancer radical resection. ASA Ⅰ ~ Ⅲ grade, age ≥60 years. Patients were divided into oxycodone group (O group, 30 cases) and sufentanil group (S group, 30 cases) by random number table. All patients were treated with left double lumen bronchial catheter in right lung Ventilation. Fifteen minutes before the end of the operation, oxycodone hydrochloride 0.07 mg / kg and isovlomiken 0.15 μg / kg were intravenously administered to both groups. Record the operation time, single lung ventilation time, intraoperative blood loss, urine output, fluid infusion volume and types; record open-eye time, respiratory recovery time, extubation time; preoperative 1 d and postoperative wakefulness assessment of ICU delirium (VAS), Riker calm restlessness score (SAS) and adverse reactions (nausea and vomiting) were recorded at PACU, , Lethargy, respiratory depression) occurred. Results Compared with group S, the open eye time, respiration recovery time and extubation time in group O were significantly shorter than those in group S (P <0.05); The incidence of delirium and the number of drowsiness were significantly decreased after operation (P <0.05); VAS And Riker sedation agitation score was significantly lower (P <0.05). Conclusion Oxycodone hydrochloride intravenously 15 min before the end of surgery can prevent the onset of general anesthesia awakening in patients with esophageal cancer undergoing radical operation.