羟考酮用于全麻诱导时对患者血流动力学及应激反应的影响

Effect of oxycodone on hemodynamics and stress response in general anesthesia induction

目的观察等效剂量的羟考酮和舒芬太尼用于全麻诱导时对患者血流动力学及应激反应的影响。方法 120例腹部手术患者分为羟考酮组(O组)和舒芬太尼组(S组),每组60例。全麻诱导:O组静注丙泊酚2.0~2.5 mg/kg、顺式阿曲库铵0.25 mg/kg、羟考酮0.25 mg/kg;S组静注舒芬太尼0.25μg/kg,其余用药及给药顺序同O组。诱导后两组均插入单腔气管导管。记录诱导前(T_0)、插管前即刻(T_1)、插管即刻(T_2)、插管后1 min(T_3)、插管后5 min(T_4)平均动脉压(MAP)、心率(HR)的变化。测定T_0、T_2、T_3、T_4各时点血浆肾上腺素(E)、去甲肾上腺素(NE)、皮质醇(Cor)及血糖(Glu)的数值。记录两组诱导期间发生呛咳的比例。结果与T0相比,(1)两组T1MAP及HR均明显降低(P<0.05),两组相比无显著性差异(P>0.05)。(2)两组T_2,T_3MAP及HR有明显升高(P<0.05),两组相比亦有显著性差异(P<0.05)。(3)两组T_4MAP及HR有所升高,但无显著性差异,两组相比亦无显著性差异(P>0.05)。(4)在T_2、T_3,两组E、NE、Cor、Glu均明显增高(P<0.05),两组相比有显著性差异(P<0.05)。在T_4,两组的E、NE、Cor、Glu均有增高,但无明显差异(P>0.05),两组相比亦无显著性差异(P>0.05)。结论静脉注射等效剂量的羟考酮和舒芬太尼行全麻诱导,羟考酮可以更有效维持血流动力学平稳,降低应激反应的发生。

Objective To investigate the effect of oxycodone and sufentanil with equivalent dose on hemo-dynamics and stress response in general anesthesia induction. Methods One hundred and twenty ASA Ⅰ or Ⅱ pa-tients with abdominal surgery were randomly divided into oxycodone group（group O,n = 60）and sufentanil group（group S,n = 60）. Anesthesia was induced with iv oxycodone 0.20 mg/kg（group O）or sufentanil 0.25 μg/kg（group S）respectively,together with iv propofol 2.0 ~ 2.5 mg/kg and cisatracurium 0.2 mg/kg. The patients weretracheally intubated using a single-lumen endotracheal tube. Mean arterial pressure（MAP）,heart rate（HR）,plas-ma levels of epinephrine（E）and norepinephrine（NE）,cortisol（Cor）and blood sugar（Glu）and the occurrence ofbucking before anesthesia induction（T0）,immediately before intubation（T_1）,at the moment of intubation（T_2）,1 min（T_3）and 5 min（T_4）after intubation were observed. Results Compared with these at T_0,MAP and HR in2 groups were lower at T_1（P〈0.05）and no significant difference was found in 2 groups（P〈0.05）. MAP and HRwere significantly higher at T_2 and T_3（P〈0.05）and compared with those in group O,MAP and HR in group Swere increased more significantly at T2 and T_3（P〈0.05）. MAP and HR increased slightly at T_4 in 2 groups but nosignificant difference was found in 2 groups（P〈0.05）. Plasma levels of E,NE,Cor and Glu increased obviouslyat T_2 and T_3in 2 groups（P〈0.05）and they were even higher in group S（P〈0.05）. Plasma levels of E,NE,Cor and Glu increased slightly at T4 in 2 groups but no significant difference was found in 2 groups（P〈0.05）.Conclusion Compared with sufentanil,oxycodone of equivalent dose used for general anesthesia induction caneffectively keep smooth on hemodynamics and decrease stress response.