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*

doi:10.3969/j.issn.1672-5069.2024.02.018

摘要/Abstract

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1 h和2 h时, C组和B组VAS评分显著低于A组(P＜0.05);在术后6 h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。

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

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 in group B or 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 in group B or 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); at 6 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 in group A or in group C; the incidences of nausea and vomiting, and respiratory depression in group C were 27.6% and 20.7%, 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^-1for 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.

Key words: Liver cirrhosis, Esophageal variceal bleeding, Endoscopic sclerotherapy, Propofol, Oxycodone, Anesthesia

王红霞, 胥晓倩, 于明帅. 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^*[J]. 实用肝脏病杂志, 2024, 27(2): 230-233.

Wang Hongxia, Xu Xiaoqian, Yu Mingshuai. 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[J]. Journal of Practical Hepatology, 2024, 27(2): 230-233.

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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

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