羟考酮与舒芬太尼用于全麻诱导时患者对双腔支气管导管插管反应和切皮反应的比较

Comparison of oxycodone and sufentanil used for anesthesia induction in inhibiting responses to tracheal intubation with double-lumen endobronchial tube and skin incision

目的:比较等效剂量盐酸羟考酮注射液与枸橼酸舒芬太尼注射液用于全麻诱导时,患者对双腔支气管导管插管反应和切皮反应的不同。方法:择期全麻下拟行单肺通气胸科手术患者60例,性别不限,年龄45~60岁,体重50~80 kg,ASAⅠ或Ⅱ级,非困难气道,采用随机数字表法分为2组(n=30)。全麻诱导分别静脉注射盐酸羟考酮0.30 mg·kg^(-1)(O组)及枸橼酸舒芬太尼0.30μg·kg^(-1)(S组),随后两组均静脉注射异丙酚2.0~2.5 mg·kg^(-1)和顺式阿曲库铵0.25 mg·kg^(-1),双腔支气管导管插管后行机械通气,七氟醚维持,切皮前不再追加镇痛药。分别于麻醉诱导前(T0)、气管插管前即刻(T1)、气管插管后即刻(T2)、气管插管后5 min(T3)和切皮(T4)时记录生命体征以及呛咳、体动反应的发生情况。结果:T2时O组血压和心率较T0时无明显变化,S组则有显著升高(P≤0.001);与O组比较,S组T2插管时血压和心率波动较大(P≤0.001)。两组切皮时血压、心率均没有显著升高,两组均未出现呛咳和体动反应。结论:相比等效剂量舒芬太尼,全麻诱导静脉注射盐酸羟考酮0.30 mg·kg^(-1)可以更有效地抑制患者对双腔支气管导管的插管反应。

Objective： To compare oxycodoneand sufentanil used for anesthesia induction in inhibiting responses to tracheal intubation with double-lumen endobronchial tube and skin incision. Methods： Sixty adult patients （aged 45 - 60 years, weighting 50 - 80 kg, with ASA physical status I or 11 , without difficult airway, scheduled for elective thoracic surgery requiring one-lung ventilation） were randomly divided into oxycodone group （n = 30） and sufentanil group （n = 30） using a random number table. Anesthesia was induced with iv oxyeodone 0.30 mg. kg - 1 （ oxycodone group） or sufentanil 0.30 I^g＂ kg- 1 （ sufentanil group） , respectively, together with iv propofol 2.0 - 2. 5 rag＂ kg-1 and cisatracurium 0.25 mg ~ kg-1 The patients were tracheally intubated using a double-lumen endobronchial tube and mechanically ventilated. Anesthesia was maintained with sevoflurane, and no anagelsic was added before skin incision. Before anesthesia induction （T0）, immediately before intubation （T1） and after intubation （T2）, 5 rain after intubation （T3）, and immediately after skin incision （T4）, mean arterial pressure （MAP） , heart rate （HR）, and the occurrence of bucking and body movement were observed. Results：MAP and HR were significantly increased at T2 as compared with T1 in sufentanil group （P≤0. 001 ） , while there was no significant difference in oxycodone group. Compared with oxycodone group, the fluctuation of MAP and HR were significantly increased in sufentanil group at T2 （P≤0. 001 ）. There was no significant elevation of MAP and HR at T4, and no incidence of bucking and body movement during the observation in both groups. Conclusion： Compared with sufentanil, oxycodone （0. 30 mg·kg-1） used for anesthesia induction can effectively inhibit responses to tracheal intubation with double-lumen endobronchial tube.