不同剂量羟考酮在全麻诱导气管插管时的临床效果

Efficacy of different doses of oxycodone during general anesthesia induction with intubation

目的比较全身麻醉诱导期间不同剂量羟考酮对气管插管的临床效果,探索羟考酮复合丙泊酚气管插管的有效合适剂量。方法择期行妇科和普外科腹腔镜手术患者80例,ASAⅠ或Ⅱ级,年龄20～60岁,随机分为4组（n=20）;羟考酮0.1 mg/kg组（Ox1组）、0.15 mg/kg组（Ox2组）、0.2 mg/kg组（Ox3组）,芬太尼3μg/kg组（F组）。静脉注射羟考酮或芬太尼,观察5 min后,静脉注射咪唑安定0.03 mg/kg,所有患者均使用丙泊酚行血浆靶控输注,丙泊酚初始浓度设置为2.5μg/m L,静脉注射罗库溴铵0.6 mg/kg。以0.1μg/m L调节丙泊酚TCI靶控输注浓度,直至伤害趋势指数（Narcotrend Index,NI）NI≤60。用喉镜经口明视下行单腔气管内插管,进行机械通气。通气参数设定：潮气量8～10 m L/kg,呼吸频率12～14次/min,维持呼气末二氧化碳分压（Pet CO2）35～40mm Hg。观察并记录诱导前基础值（T0）,诱导药物注射后（T1）,显露声门时刻（T2）,插管即刻（T3）,插管后1 min（T4）、2 min（T5）、3 min（T6）、4 min（T7）、5 min（T8）、10 min（T9）的收缩压（SBP）、舒张压（DBP）、心率（HR）以及NI变化,并记录患者有无呛咳。结果与F组比较,Ox2组和Ox3组在T1～T9各时间点的HR、SBP和DBP差异无统计学意义（P〉0.05）。与Ox2、Ox3和F组比较,Ox1组T3和T4 HR、SBP和DBP明显升高（P〈0.05）。四组间各时点NI值比较差异无统计学意义（P〉0.05）。Ox3组和F组呼吸抑制明显（P〈0.05）。结论 （1）盐酸羟考酮注射液复合丙泊酚用于麻醉诱导的效果与芬太尼复合丙泊酚的效果相似。（2）盐酸羟考酮注射液0.15 mg/kg的诱导剂量更适合用于本组全麻诱导。

Objective To compare efficacy of different doses of oxycodone during induction of general anesthesia and to determine the appropriate dosage. Methods Eighty ASA Ⅰ or Ⅱ patients aged 20 ～ 60 years undergoing elective laparoscopic surgery of gynecology or general surgery under general anesthesia were divided into 4 groups（ n = 20 each）according to the following oxycodone doses,0. 1 mg / kg（ Ox1）,0. 15 mg / kg（ Ox2）,0. 2 mg / kg（ Ox3）,and fentanyl doses 3 μg / kg（ F）. Anesthesia was induced with oxycodone or fentanyl. After 5 minutes,intravenous midazolam 0. 03 mg /kg was administered with target controlled infusion（ TCI） of propofol（ initial concentration set to 2. 5 μg / m L）. Rocuronium 0. 6 mg / kg was injected IV. TCI of propofol was titrated at 0. 1 μg / m L until the narcotrend index（ NI） ≤60. Tracheal intubation was then performed by single- cavity laryngoscopy. Mechanical ventilation was set at tidal volume of 8 ～ 10 m L / kg,respiratory rate of 12 ～ 14 / min,end- respiratory Pet CO2 of 35 ～ 40 mm Hg. SBP,DBP,MAP and NI were continuously monitored during anesthesia and recorded immediately before induction（ T0,baseline）,immediately before intubation（ T1）,exposure of glottis（ T2）,immediately and 1,2,3,4,5,10 min after intubation（ T3 ～ T9）. Results Compared with Group F,HR,SBP and DBP in Groups Ox2 and Ox3 were similar at each time point from T1 ～ T9（ P〉0. 05）. HR,SBP and DBP in Group Ox1 at T3 and T4 were higher than those in Groups Ox2,Ox3 and F（ P〈0. 05）.There was no significant difference in NI among all groups. There was obvious respiratory depression in Group Ox3 and Group F（ P〈0. 05）. Conclusion 1. Oxycodone combined with propofol for induction of anaesthesia has similar efficacy as fentanyl combined with propofol. 2. Oxycodone at 0. 15 mg / kg is the appropriate dose during induction of anesthesia in this setting.