羟考酮麻醉诱导咳嗽发生率及对血流动力学影响研究

Incidence of cough caused by oxycodone during induction of general anesthesia and its influence on hemodynamics

目的阿片类镇痛药在气管插管全身麻醉快速诱导中常引起咳嗽,本研究比较静脉注射羟考酮和芬太尼引起咳嗽的发生率和严重程度以及相关血流动力学指标变化,为全麻诱导时阿片类药物的选择提供依据。方法选择山东大学附属山东省肿瘤医院2016-04-01-2017-12-01拟行择期手术240例患者为研究对象,ASA分级(美国麻醉医师协会2016年版麻醉分级)Ⅰ~Ⅲ级。入组患者根据手术先后顺序采用随机数字表法分为O组、F组和N组3组,每组80例。O组为羟考酮组,静脉注射盐酸羟考酮注射液0.25mg/kg;F组为芬太尼组,静脉注射枸橼酸芬太尼注射液2.5μg/kg;N组为安慰剂组,静脉注射等容量0.9%生理盐水;5s注射完毕。观察给药前(T1)脉搏氧饱和度(SpO2)、心率(HR)和平均动脉压(MAP),给药后(T2)2min内咳嗽次数(n)、第1次咳嗽出现时间(s)、SpO2、HR和MAP,静脉注射其他药物继续进行全身麻醉诱导。咳嗽的严重程度根据2min内咳嗽次数分为无咳嗽(0次)、轻度(1~2次)、中度(3~4次)和重度(>5次)咳嗽。结果 N组患者没有出现咳嗽,O组患者咳嗽发生率为10.4%(8/77),明显低于F组35.9%(28/78),χ2=39.095,P<0.001。O组出现轻度咳嗽5例,中度3例,重度0例,F组出现轻度咳嗽8例,中度17例,重度3例,χ2=3.347,P=0.067;第一次咳嗽发生时间O组为(30.4±7.9)s,F组为(25.8±5.8)s,差异无统计学意义,t=1.800,P=0.081。Logistic回归分析发现,F组咳嗽发生率和年龄(OR=0.922,95%CI为0.873~0.974)相关;相对于T1,F组的MAP、HR和SpO2在T2均显著降低,差异有统计学意义,均P<0.05;O组MAP和SpO2显著降低,差异有统计学意义,均P<0.05。结论等效剂量的羟考酮和芬太尼经静脉注射用于全麻诱导,羟考酮引起咳嗽的发生率低,呼吸抑制轻,对血流动力学影响较小。

OBJECTIVE To investigate the effect of oxycodone and fentanyl with equivalent dose on the incidence and severity of cough and the related to hemodynamic indexes, and provide the evidence of opioid drugs for induction of general anesthesia. METHODS This study included 240 patients who were scheduled to undergo elective surgery in Shandong Cancer Fiospital from April 1st 2016 to December 1st 2017 with ASA （American Association of Anesthesiologists） Grade Ⅰ-Ⅲ. The patients were randomly divided into 3 groups with 80 cases in each group according to the order of op- eration by the table of random number. Patients received either oxyeodone 0. 25 mg/kg（group-O）, fentanyl 2. 5 μg/kg （group-F） and equal volume of 0. 9% normal saline（group-N） administered intravenously in 5s. Oxygen saturation （SpO2）, Heart rate （HR） and Mean arterial pressure （MAP） before administration （T1）, the number of coughing （n） within 2 min after dosing,time for the first cough （s）,and the datas of SpO2 ,FIR,MAP on 2 rain after dosing （T2） were all recorded. The severity of coughing was graded as no cough （0）,mild （1-2） ,moderate （3-5） and severe （〉5） ac-cording to the number of cough. RESULTS （1） The incidence of cough was significantly lower in group-O（8/77;10.4%） than that in group-F（28/78;35.9%）. The patients in group-N did not have a cough （χ^2=39. 095,P〈0. 001）. （2） There was no significant difference between the group O and the group-F on onset time [group-O was （30.4 ± 7.9） s; group-F was （25.8±5.8） s;t= 1. 800,P=0. 081] and severity of cough（group-O：mild 5 ,moderate 3,severe 0;group-F： mild 8,moderate 17,severe 3;χ^2=3. 347,P=0. 067）. （3）It was found that there was a correlation on coughing incidence and age of cough in Group-F（OR, 95% CI）=[0. 922 （0. 873±0. 974）]; （4） Group -F had signficant reduction between T1 and T2 on MAP, HR and SpO2 （P〈0.05） ,group-O had significant reduction between T1 and T2 on SpO2 and MAP（P〈 0.05）. CONCLUSION The equivalent of fentanyl and oxycodone are injected by intravenous for anesthesia induction,the incidence of cough induced by hydroxycodone is lower and the inhibition of respiration is less, and the hemodynamics is less affected.