不同剂量羟考酮缓解甲状腺术后气管拔管反应的比较  

Comparison of responses induced by tracheal extubation between different doses of oxycodone after thyroidectomy

作　　者：李佳佳[1] 盛毅 黄梦朦 韩园[1] 朱纯纯[1] 刘华程[1] 李军[1] LI Jiajia;SHENG Yi;HUANG Mengmeng;HAN Yuan;ZHU Chunchun;LIU Huacheng;LI Jun(Department of Anesthesiology, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027,Zhejiang, China;The Second Clinical Medical College of Wenzhou Medical University, Wenzhou 325035, Zhejiang, China)

机构地区：[1]温州医科大学附属第二医院麻醉科,浙江温州325027 [2]温州医科大学第二临床医学院,浙江温州325035

出　　处：《中国临床药理学与治疗学》2019年第11期1287-1292,共6页Chinese Journal of Clinical Pharmacology and Therapeutics

基　　金：浙江省自然科学基金一般项目(LY17H310006)

摘　　要：目的:比较不同剂量羟考酮对甲状腺手术患者全麻恢复期气管拔管反应的影响。方法:选取80例择期行甲状腺手术的患者,随机分为四组。四组患者接受统一麻醉诱导及维持用药方案,手术结束前20~40 min分别静推0.05 mg/kg羟考酮(Q1)、0.1 mg/kg羟考酮(Q2)、0.15 mg/kg羟考酮(Q3)和等容积生理盐水(C)。记录四组患者麻醉诱导前(T0)、拔管时(T1)、拔管后5 min(T2)、拔管后10 min(T3)的平均动脉压(MAP)、心率(HR)和自主呼吸恢复时间、苏醒时间、拔管时间、拔管时的呛咳反应与程度,以及入恢复室后5 min、15 min、30 min警觉/镇静评分、视觉模拟评分(VAS)及药物不良反应。结果:与T0相比,C、Q1组患者在T1、T2时点MAP升高、HR加快(P<0.05),而Q2、Q3组T1~T3时点的差异无统计学意义(P>0.05);与C组相比,Q1组患者MAP、HR的差异无统计学意义(P>0.05),Q2、Q3组的差异有统计学意义(P<0.05)。与C组相比,Q2、Q3组患者气管拔管时的呛咳反应明显缓解(P<0.05),Q3组患者自主呼吸恢复时间和拔管时间延长(P<0.05),三羟考酮组患者在麻醉后监测治疗室(PACU)的VAS评分明显下降(P<0.05)。结论:手术结束前20~40 min应用羟考酮可减轻甲状腺手术患者全麻恢复期的气管拔管反应,且0.1 mg/kg羟考酮为最适剂量,效果显著,术后镇痛效果良好,不良反应少,更安全。AIM:To investigate the differences of the reaction induced by tracheal extubation between different doses of oxycodone after thyroidectomy.METHODS:After the unified anesthesia induction and maintenance regimen,eighty patients undergoing elective thyroidectomy were randomly divided into four groups receiving 0.05 mg/kg(group Q1),0.1 mg/kg(group Q2),0.15 mg/kg(group Q3)of intravenous oxycodone,or the same capacity of normal saline(group C)at 20-40 min before the end of surgery.MAP and HR were measured before anesthesia induction(T0),immediately after extubation(T1),at 5(T2)and 10 min(T3)after extubation.The recovery time of postoperative spontaneous breathe,awakening time,extubated time and the cough reflex caused by extubation were recorded.In addition,the OAA/S and VAS scores were marked at 5 min,15 min,30 min after entering the recovery room.RESULTS:Compared with T0,MAP and HR of group C and Q1 at T1,T2 increased significantly(P<0.05),while those of group Q2 and Q3 had no differences(P>0.05).Compared with group C,MAP and HR in group Q2,Q3 were lower(P<0.05)while those of group Q1 had no differences(P>0.05);the cough reflex of group Q2 and Q3 were lighter(P<0.05);the patients in group Q3 had the longer recovery time of postoperative spontaneous breathe and extubated time(P<0.05).Also,the VAS scores in PACU of three Q groups were lower than group C(P<0.05).CONCLUSION:Oxycodone administered at 20-40 min before the end of surgery can alleviate responses induced by extubation of the patients after thyroidectomy.0.1 mg/kg of intravenous Oxycodone is the best dose for it can offer a better quality of recovery and postoperative analgesia with the fewer side effects.

关 键 词：羟考酮 甲状腺切除术 气管拔管反应 

分 类 号：R614[医药卫生—麻醉学] R653[医药卫生—外科学]