静脉注射羟考酮对全麻后拔管时生理反应的影响。
Effect of intravenous oxycodone on the physiologic responses to extubation following general anesthesia.
机构信息
Department of Anesthesiology, Wuxi 9th Affiliated Hospital of Soochow University, No. 999 Liangxi Rd, 214062, Wuxi, China.
出版信息
BMC Anesthesiol. 2021 May 12;21(1):146. doi: 10.1186/s12871-021-01350-5.
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 (SpO) as well as blood concentrations of epinephrine, norepinephrine, and cortisol were recorded or measured immediately before extubation (T), during extubation (T), as well as one minute (T), 5 min (T), and 10 min after extubation (T). 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.
TRIAL REGISTRATION
Chinese Clinical Trial Registry: ChiCTR2000040370 (registration date: 11-28-2020) "'retrospectively registered".
背景
气管插管和拔管可能会引起不良的血流动力学变化。静脉注射羟考酮最近已被引入并用于缓解气管插管引起的血流动力学改变，但关于其在全麻苏醒期拔管时稳定血流动力学的应用，信息还不够充分。
方法
100 例接受全身麻醉下各种腹腔镜手术的患者，随机分为对照组（生理盐水注射，50 例）和研究组（手术结束后立即静脉注射 0.08mg/kg 羟考酮，50 例）。记录或测量血压、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浓度，分别在拔管前（T）、拔管时（T）、拔管后 1 分钟（T）、5 分钟（T）和 10 分钟（T）。此外，分析咳嗽和烦躁、睁眼时间、手术完成到拔管的时间以及 Ramsay 镇静评分。
结果
与研究组相比，对照组在拔管时以及拔管后 1、5 和 10 分钟时，血压、心率以及肾上腺素、去甲肾上腺素和皮质醇的血浓度均显著升高（P<0.05）。当患者从全麻中苏醒时，对照组有 70%的患者咳嗽，明显高于研究组（40%，P<0.05）。对照组有更多的患者在拔管前（40%）和拔管后（20%）表现出烦躁，而研究组分别为 20%和 2%（P<0.05）。此外，对照组患者在拔管时（1.7±0.7）和拔管后 30 分钟（2.4±0.9）的 Ramsay 评分均较低，而研究组分别为 2.2±0.9 和 3.0±0.8（P=0.003 和 0.001）。
结论
静脉注射羟考酮可减轻全麻苏醒期拔管时与血流动力学和血液激素变化相关的变化。
试验注册
中国临床试验注册中心：ChiCTR2000040370（注册日期：2020 年 11 月 28 日）“回顾性注册”。
Zotero 插件