羟考酮复合右美托咪定对甲状腺腔镜手术患者全身麻醉气管插管应激反应的影响

Effect of oxycodone combined with dexmedetomidine on stress response of general anesthesia for intubation in patients undergoing endoscopic thyroid surgery

目的 比较羟考酮复合右美托咪定与舒芬太尼复合右美托咪定在甲状腺腔镜手术全身麻醉气管插管时对患者应激反应的影响。方法 选取杭州市第一人民医院2022年2月至2024年2月收治的84例行甲状腺腔镜手术患者,按随机数字表法分为两组,每组42例。两组患者均先给予右美托咪定0.5μg·kg^(-1),对照组使用舒芬太尼0.3μg·kg^(-1)静脉输注,观察组使用羟考酮0.2 mg·kg^(-1)静脉输注。对比两组患者一般资料、不同时间点[麻醉前(T_(0))、插管时(T_(1))、插管后1 min(T_(2))、插管后5 min(T_(3))]生命体征指标[心率(HR)、平均动脉压(MAP)]、不同时间点应激指标[血浆肾上腺素(E)和去甲肾上腺素(NE)]、用药后及插管期间不良反应发生情况。结果 在T_(1)时间点,对照组和观察组患者的HR[分别为(53.08±6.24)次·min^(-1)、(65.13±7.32)次·min^(-1)]、MAP[分别为[(77.62±8.27) mm Hg、(78.31±9.35) mm Hg (1 mm Hg≈0.133 kPa)]均低于T_(0)时间的HR[分别为(74.72±10.51)次·min^(-1)、(76.61±9.62)次·min^(-1)]、MAP[分别为(93.25±8.57) mm Hg、(94.87±10.59) mm Hg],且T_(1)时间点对照组HR低于观察组(P<0.05);在T_(2)时间点,对照组和观察组患者HR[分别为(92.48±9.51)次·min^(-1)、(71.64±7.49)次·min^(-1)]、MAP[分别为(105.67±7.82) mm Hg、(96.18±10.04) mm Hg]均上升;在T_(3)时间点,对照组和观察组患者HR[分别为(87.92±8.16)次·min^(-1)、(74.27±7.56)次·min^(-1)]、MAP[分别为(101.46±8.97) mm Hg、(97.53±9.42) mm Hg]均上升,且对照组HR、MAP均高于观察组(均P<0.05)。与T_(0)时间点比较,对照组和观察组患者E、NE浓度在T_(1)[分别为(37.08±6.24) ng·mL^(-1)、(427.62±74.27) pg·mL^(-1)、(32.16±7.32) ng·mL^(-1)、(384.31±70.35) pg·mL^(-1)]、T_(2)[分别为(36.48±7.51) ng·mL^(-1)、(421.67±60.82) pg·mL^(-1)、(31.64±6.49) ng·mL^(-1)、(373.18±65.04) pg·mL^(-1)]、T_(3)时间点[分别为(34.62±6.47) ng·mL^(-1)、(397.46±58.97) pg·mL^(-1)、(29.47±7.12) ng·mL^(-1)、(361.53±51.42) pg·mL^(-1)]均高于T_(0)时间[分别为(24.92±4.51) ng·mL^(-1)、(327.25±60.57) pg·mL^(-1)、(25.31±4.62) ng·mL^(-1)、(329.87±61.59) pg·mL^(-1)],且对照组E、NE浓度均高于观察组(均P<0.05)。在不良反应总发生率方面,观察组低血压、心动过缓、呛咳不良反应发生率[分别为7.14%(3/42)、4.76%(2/42)、2.38%(1/42)]低于对照组[分别为28.57%(12/42)、21.43%(9/42)、19.05%(8/42)](均P<0.05);对照组患者高血压、心动过速、SpO_(2)<90%不良反应发生率[分别为4.76%(2/42)、9.52%(4/42)、4.76%(2/42)]与观察组[分别为0(0/42)、2.38%(1/42)、0(0/42)]比较差异无统计学意义(均P>0.05)。结论 羟考酮复合右美托咪定用于甲状腺腔镜手术患者全身麻醉插管前诱导麻醉效果较好,可稳定血流动力学,减轻全身麻醉插管应激反应,且安全性高。

Objective To compare the effect of hydrocodone combined with dexmedetomidine with that of sufentanil combined with dexmedetomidine on patient stress response during general anesthesia for intubation in thyroid endoscopy surgery.Methods A total of 84 patients who underwent thyroid endoscopy surgery in Hangzhou First People's Hospital from February 2022 to February 2024 were selected as the research subjects and divided into the observation group and control group using a random number table method,with 42 in each group.All the patients in both groups were firstly given dexmedetomidine at a dose of 0.5μg·kg^(-1).The patients in the control group received sufentanil 0.3μg·kg^(-1) via intravenous infusion and those in the observation group received hydrocodone 0.2 mg·kg^(-1) via intravenous infusion.The general data,physical indicators(heart rate(HR),mean arterial pressure(MAP)),stress indicators(plasma adrenaline(E)and norepinephrine(NE))concentrations,and adverse reactions at different time points(before anesthesia(T0),during intubation(T_(1)),1 minute after intubation(T_(2)),and 5 minutes after intubation(T_(3)))were compared between the two groups. Results At the T_(1) time point, the HR and MAP were (53.08±6.24) times·min^(-1) and (65.13±7.32) times·min^(-1) in the control group and (77.62±8.27) mm Hg and (78.31±9.35) mm Hg(1 mm Hg≈0.133 kPa) in the observation group. At the T_(0) time point, the HR of the control group was lower than that of the observation group ((74.72 ±10.51) times·min^(-1) vs (76.61±9.62) times·min^(-1)) and the MAP was (93.25±8.57) mm Hg and (94.87±10.59) mm Hg, respectively. The HR of the control group was lower than that of the observation group (P<0.05). At the T_(2) time point, the HR was (92.48±9.51) times·min^(-1) and (71.64±7.49) times·min^(-1) while MAP was (105.67±7.82) mm Hg and (96.18±10.04) mm Hg in the control group and the observation group, demonstrating increase. At the T_(3) time point, the HR was (87.92±8.16) times·min^(-1) and (74.27±7.56) times·min^(-1) while MAP was (101.46±8.97) mm Hg, (97.53± 9.42) mm Hg in the control group and observation group, showing increase. Meanwhile, they were significantly higher in the control group than in the observation group (all P<0.05). At the T_(0) time point, the concentrations of E and NE in the control group and study group were (24.92 ± 4.51) ng·mL^(-1), (327.25 ± 60.57) pg·mL^(-1), (25.31±4.62) ng·mL^(-1), (329.87±61.59) pg·mL^(-1). They were (37.08± 6.24) ng·mL^(-1), (427.62±74.27) pg·mL^(-1), (32.16 ± 7.32) ng·mL^(-1), (384.31±70.35) pg·mL^(-1) at the T_(1) time point, (36.48±7.51) ng·mL^(-1), (421.67±60.82) pg·mL^(-1), (31.64±6.49) n·mL^(-1), (373.18±65.04) pg·mL^(-1) at the T_(2) time point and (34.62±6.47) ng·mL^(-1), (397.46± 58.97) pg·mL^(-1), (29.47 ± 7.12) ng·mL^(-1), (361.53±51.42) pg·mL^(-1) at the T_(3) time point. They were all higher at T_(1), T_(2) and T_(3) time point than those at T0 time point. Meanwhile, they were significantly higher in the control group than in the observation group (all P<0.05). The incidence of adverse reactions including hypertension, tachycardia and SpO_(2)<90% in the control group was 4.76% (2/42), 9.52% (4/42) and 4.76% (2/42) and it was not significantly different from that of 0.00% (0/42), 2.38% (1/42) and 0.00% (0/42) in the observation group (all P>0.05). Conclusion Oxycodone combined with dexmedetomidine is effective in inducing anesthesia before general anesthesia for intubation in patients undergoing endoscopic thyroid surgery. It can stabilize the hemodynamic indexes of patients and reduce the stress response of patients undergoing general anesthesia for intubation. Furthermore, it is safe and worthy of clinical application.