全身麻醉诱导期间不同剂量羟考酮对气管插管麻醉的临床效果比较

Comparison of the effects of different doses of oxycodone on endotracheal intubation during general anesthesia induction period

目的 比较全身麻醉诱导期间不同剂量羟考酮对气管插管麻醉的临床效果.方法 选取需气管插管全身麻醉手术患者95例为研究对象,按随机数字表法分为A组、B组、C组.A组31例患者静脉注射羟考酮0.20 mg/kg,B组32例患者静脉注射羟考酮0.25 mg/kg,C组32例患者静脉注射羟考酮0.30 mg/kg.比较三组患者不同时间点[T0（入室后10 min）、T1（诱导后气管插管前即刻）、T2（气管插管后1min）、T3（气管插管后3 min）、T4（气管插管后5 min）]的肾上腺素、去甲肾上腺素、多巴胺浓度以及平均动脉压、心率.结果 三组T1时平均动脉压、心率与TO时相比均有不同程度的下降（t=23.618、7.412;22.928、9.063;32.636、9.422,P=0.000、0.000;0.000、0.000;0.000、0.000）;A组心率、平均动脉压在T2、T3、T4时与TO时相比均有升高（t=13.834、6.506、7.015;17.604、14.796、16.323,P=0.000、0.000、0.000;0.000、0.000、0.000）;A组肾上腺素、去甲肾上腺素、多巴胺在T2、T3、T4时与TO时相比均升高（t=121.662、64.533、15.687;31.498、16.933、9.286;39.712、116.049、147.102,P =0.000、0.000、0.000;0.000、0.000、0.000;0.000、0.000、0.000）;B组、C组T2、T3、T4时的心率、平均动脉压以及肾上腺素、去甲肾上腺素、多巴胺与A组相比明显降低（t=19.586、31.972,16.844、27.087;14.046、14.822,15.377、23.826;7.756、14.396,13.268、23.342,100.573、104.010,37.612、38.892,107.377、117.969;56.135、56.757,24.223、25.300,95.057、82.088;22.878、25.731,5.532、5.934,134.763、83.628,P=0.000、0.000,0.000、0.000,0.000、0.000;0.000、0.000,0.000、0.000,0.000、0.000;0.000、0.000,0.000、0.000,0.000、0.000;0.000、0.000,0.000、0.000;0.000、0.000,0.000、0.000;0.000、0.000,0.000、0.000）.结论 全身麻醉诱导期间,气管插管患者应用羟考酮的适宜剂量为0.25mg/kg,能够有效维持平均动脉压等血流动力学稳定,降低患者应激反应.

Objective To compare the clinical effect of different doses of oxycodone on endotracheal intubation during general anesthesia induction period.Methods Ninety-five patients with endotracheal intubation general anesthesia were selected as the research subjects,and the patients were randomly divided into group A,group B and group C.31 patients in group A received intravenous administration of oxycodone 0.20mg/kg,32 patients in group B received intravenous administration of oxycodone 0.25mg/kg,and 32 patients in group C received intravenous administration of oxycodone 0.30mg/kg.The adrenaline,norepinephrine,dopamine concentration,as well as mean arterial pressure and heart rate at different time points were compared among the three groups.Results The mean arterial pressure and heart rate at T0 time point were decreased to varying extent compared with those at T1 time point（t =23.618,7.412;22.928,9.063;32.636,9.422,P =0.000,0.000;0.000,0.000;0.000,0.000）.The heart rate,mean arterial pressure at T2,T3 and T4 time points in group A were increased compared with T0 time point （t =13.834,6.506,7.015;17.604,14.796,16.323,P =0.000,0.000,0.000;0.000,0.000,0.000）.The adrenaline,norepinephrine and dopamine at T2,T3 and T4 time points in group A were increased compared witb T0 time point （t =121.662,64.533,15.687;31.498,16.933,9.286;39.712,116.049,147.102,P =0.000,0.000,0.000;0.000,0.000,0.000;0.000,0.000,0.000）.The heart rate,mean arterial pressure,adrenaline,norepinephrine and dopamine at T2,T3 and T4 time points in group B and group C were decreased significantly compared with those in group A （t =19.586,31.972,16.844,27.087;14.046,14.822,15.377,23.826;7.756,14.396,13.268,23.342,100.573,1 04.010,37.612,38.892,107.377,117.969;56.135,56.757,24.223,25.300,95.057,82.088;22.878,25.731,5.532,5.934,134.763,83.628,P =0.000,0.000,0.000,0.000,0.000,0.000;0.000,0.000,0.000,0.000,0.000,0.000;0.000,0.000,0.000,0.000,0.000,0.000;0.000,0.000,0.000,0.000;0.000,0.000,0.000,0.000;0.000,0.000,0.000,0.000）,and the differences were statistically significant （all P 〈 0.05）.Conclusion During the induction of general anesthesia,the appropriate dose of oxycodone in patients with endotracheal intubation was 0.25mg/kg,which could effectively maintain the hemodynamic stability,such as mean arterial pressure,and could reduce the stress response.