羟考酮或舒芬太尼复合依托咪酯用于烟雾病患者麻醉诱导的对比研究

Comparative study of Oxycodone or Sufentanil combined with Etomidate for anesthesia induction in patients with moyamoya disease

目的探讨等效剂量的羟考酮与舒芬太尼复合依托咪酯用于烟雾病患者麻醉诱导期间的血流动力学变化及麻醉质量。方法选择2019年5月至11月解放军总医院第五医学中心南院区收治的烟雾病患者80例为研究对象。依据随机数字表法,将其分为羟考酮组(OX组)和舒芬太尼组(SF组),每组40例。进入手术室后建立静脉通路,行有创动脉监测。麻醉诱导:OX组静脉注射盐酸羟考酮注射液0.25 mg/kg,SF组静脉注射等效剂量的枸橼酸舒芬太尼注射液0.25μg/kg,观察2 min内有无咳嗽及肌肉痉挛、呼吸抑制等发生。两组均静脉注射依托咪酯0.3 mg/kg、咪达唑仑2 mg、盐酸戊乙奎醚0.3 mg、格拉司琼3 mg和罗库溴铵0.6 mg/kg,待患者肌松充分置入喉罩,机械通气。观察并记录两组麻醉诱导前(T_(0))、注射羟考酮/舒芬太尼后2 min(T_(1))、喉罩置入前(T_(2))、喉罩置入即刻(T_(3))、喉罩置入后1 min(T_(4))的心率(HR)、平均动脉压(MAP)。结果OX组咳嗽发生率低于SF组,差异有统计学意义(P<0.05)。两组头晕恶心、呼吸抑制发生率比较,差异无统计学意义(P>0.05)。SF组T_(1)时HR、MAP高于T_(0),差异有统计学意义(P<0.05)。OX组T_(1)时HR、MAP低于SF组,差异有统计学意义(P<0.05),其余时刻HR、MAP两组间比较,差异无统计学意义(P>0.05)。结论羟考酮复合依托咪酯进行烟雾病麻醉诱导,效果安全可靠,且较舒芬太尼诱导不良反应发生率低,血流动力学稳定。

Objective To investigate the hemodynamic changes and anesthesia quality of patients with moyamoya disease treated with equivalent dose of Oxycodone and Sufentanil combined with Etomidate during anesthesia induction.Methods A total of 80 patients with moyamoya disease who admitted to Nanyuan District,the Fifth Medical Center,General Hospital of Chinese People’s Liberation Army from May to November 2019 were selected as study objects.They were divided into Oxycodone group(OX group)and Sufentanil group(SF group),with 40 cases in each group.After entering the operating room,venous access was established and invasive arterial monitoring was performed.Anesthesia induction:Oxycodone Hydrochloride Injection 0.25 mg/kg was injected intravenously in OX group,and Sufentanil Citrate Injection 0.25μg/kg was injected intravenously in SF group,cough,muscle spasm,and respiratory depression were observed within two minutes.Then,Etomidate 0.3 mg/kg,Midazolam 2 mg,Penehyclidine Hydrochloride 0.3 mg,Granisetron 3 mg and Rocuronium 0.6 mg/kg were injected intravenously in both groups.After the patients were fully relaxed,laryngeal mask was inserted and mechanical ventilation was performed.Heart rate(HR)and mean arterial pressure(MAP)were observed and recorded before anesthesia induction(T_(0)),two minutes after Oxycodone/Sufentanil injection(T_(1)),before laryngeal mask implantation(T_(2)),immediately after laryngeal mask implantation(T_(3))and one minutes after laryngeal mask implantation(T_(4)).Results The incidence of cough in OX group was lower than that in SF group,and the difference was statistically significant(P<0.05).There were no significant differences in the incidence of dizziness and nausea,and respiratory depression between two groups(P>0.05).In SF group,HR and MAP at T_(1) were higher than those at T_(0),and the differences were statistically significant(P<0.05).HR and MAP at T_(1) in OX group were lower than those in SF group,and the differences were statistically significant(P<0.05),but there were no significant differences between HR and MAP in two groups at other time points(P>0.05).Conclusion The effect of Oxycodone combined with Etomidate on anesthesia induction of moyamoya disease is safe and reliable,and the incidence of adverse reactions is lower than Sufentanil induction,and the hemodynamics is stable.