【罂粟摘要】静脉注射羟考酮对全身麻醉拔管时生理反应产生的影响
静脉注射羟考酮对全身麻醉拔管时生理反应产生的影响
贵州医科大学 高鸿教授课题组
翻译：张中伟 编辑：佟睿 审校：曹莹
气管插管和拔管可能会引起不良的血液动力学变化。静脉注射羟考酮这种方法最近被引入并用于缓解气管插管后引起的不良血流动力学变化，但关于其在全麻患者拔管期间稳定血流动力学的应用信息尚且不足。
将100名在全身麻醉下接受各种腹腔镜手术的患者随机分为两组，对照组(生理盐水注射，50例)和研究组(手术完成后立即静脉注射0.08毫克/千克羟考酮，50例)。在拔管前(T0)、拔管期间(T1)、拔管后1分钟(T2)、5分钟(T3)和10分钟(T4)测量并记录血压、心率、血氧饱和度(SpO2)以及肾上腺素、去甲肾上腺素和皮质醇的血液浓度。此外，还分析了咳嗽和躁动的发生、睁眼时间、从完成手术到拔管的时间以及拉姆齐镇静量表。
在拔管时以及拔管后1分钟、5分钟、10分钟这四个时间点，对照组的血压和心率以及肾上腺素、去甲肾上腺素和皮质醇的血药浓度显著高于研究组(P < 0.05)。当接受全身麻醉的患者苏醒时，对照组有70%的患者出现咳嗽，数量明显高于研究组(40%，P < 0.05)。对照组在拔管前(40 %)和拔管后(20%)出现躁动的患者数量明显高于研究组(分别为20%和2%，P< 0.05)。此外，对照组患者拔管时的拉姆齐评分(1.7±0.7)和拔管后30分钟的拉姆齐评分(2.4±0.9)低于研究组患者(分别为2.2±0.9和3.0±0.8，P = 0.003和0.001)。
静脉注射羟考酮可减轻全麻苏醒时期拔管引起的血流动力学变化和血液激素水平的变化。
Effect of intravenous oxycodone on the
physiologic responses to extubation
following general anesthesia
Abstract
Background: Endotracheal intubation and extubation may cause undesirable hemodynamic changes. Intravenous oxycodone has recently been introduced and used for relieving hemodynamic alterations in response to intubation,but there is insufficient information regarding its application in stabilizing hemodynamics during extubation in the patients emerging from general anesthesia.
Methods: One hundred patients, who had undergone assorted laparoscopic surgeries under general anesthesia,were randomly assigned to Control group (saline injection, 50 cases) and Study group (intravenous injection of，0.08 mg/kg oxycodone immediately after completion of the surgical procedure, 50 cases). Blood pressure, heart rate, blood oxygen saturation (SpO2) as well as blood concentrations of epinephrine, norepinephrine, and cortisol were recorded or measured immediately before extubation (T0), during extubation (T1), as well as one minute (T2),
5 min (T3), and 10 min after extubation (T4). In addition, coughing and restlessness, time of eye-opening, and duration from completing surgery to extubation as well as Ramsay Sedation Scale were analyzed.
Results: Blood pressure and heart rate as well as blood concentrations of epinephrine, norepinephrine, and cortisol were significantly higher in the Control group compared with the Study group at the time of extubation as well as 1, 5, and 10 min after extubation (P < 0.05). When the patients emerged from general anesthesia, 70 % of the Control group had cough, which was significantly higher than that of Study group (40 %, P < 0.05). Significantly higher number of patients manifested restlessness in the Control group before (40 %) and after extubation (20 %) compared with that in the Study group (20 and 2 %, respectively, P< 0.05). In addition, patients of Control group had lower Ramsay score at extubation (1.7 ± 0.7) as well as 30 min after extubation (2.4 ± 0.9) compared to that of the patients of Study group (2.2 ± 0.9, and 3.0 ± 0.8, respectively, P = 0.003 and 0.001).
Conclusions: Intravenous oxycodone attenuated alterations of hemodynamics and blood hormones associated with extubation during emergence from general anesthesia.
翻译：张中伟
编辑：佟睿
审校：曹莹