不同剂量氢吗啡酮用于全身麻醉诱导对患者血流动力学和应激水平的影响

Effect of Hydromorphone on hemodynamics and stress response in general anesthesia induction

摘要:

目的 观察不同剂量氢吗啡酮对全身麻醉诱导气管内插管患者血流动力学的影响，探讨氢吗啡酮用于气管内插管的可行性。方法 选取ASA Ⅰ、Ⅱ级，全身麻醉诱导气管内插管的患者80例，采用随机数表法分为A、B、C、D 4组，每组20例。每组麻醉诱导前均输注乳酸林格液8.0?ml/kg、静脉注射咪达唑仑0.05?mg/kg。A组给予芬太尼5.0?μg/kg、罗库溴铵0.6?mg/kg、丙泊酚2.0?mg/kg诱导；B组给予氢吗啡酮0.04?mg/kg、罗库溴铵0.6?mg/kg、丙泊酚2.0?mg/kg诱导；C组给予氢吗啡酮0.06?mg/kg、罗库溴铵0.6?mg/kg、丙泊酚2.0?mg/kg诱导；D组给予氢吗啡酮0.08?mg/kg、罗库溴铵0.6?mg/kg、丙泊酚2.0?mg/kg诱导。记录麻醉诱导前（T0）、插管即刻（T1）、插管后1?min（T2）、插管后3?min（T3）、插管后5?min（T4）5个时间点的收缩压（SBP）、舒张压（DBP）、心率（HR）和血氧饱和度（SpO2）。应用高效液相色谱分析法检测T0、T1、T2、T3、T4时的静脉血血浆肾上腺素（E）、去甲肾上腺素（NE）和多巴胺（DA）水平。4组使用微泵输注丙泊酚和瑞芬太尼维持麻醉。结果 各组内的HR在T1、T2、T3时高于T0（P?<0.05）。A组内的HR在T4时高于T0（P?<0.05）；D组的HR在T1、T2、T3、T4时低于A、B、C 3组（P?<0.05）；A、B、C 3组内的SBP、DBP在T1、T2、T3时高于T0（P?<0.05），D组的SBP、DBP在T1、T2、T3、T4时低于A、B、C 3组（P?<0.05）；A、B、C、D 4组的E、NE、DA在T1、T2、T3、T4时与T0时比较，均升高（P?<0.05）。D组的E、NE、DA在T1、T2、T3、T4时低于A、B、C 3组（P?<0.05）。A、B、C 3组内的E、NE、DA在T1、T2、T3、T4时无差异（P?>0.05）。结论 全身麻醉诱导时静脉注射氢吗啡酮0.08?mg/kg可有效抑制患者气管插管造成的应激反应，获得稳定的血流动力学。

Abstract:

Objective To explore the influence of hydromorphone on the hemodynamics and stress response during general anesthesia induction. Methods Totally 80 patients undergoing general anaesthesia with ASA grade I/II were involved in this study. All patients received Propofol (2.0?mg/kg) and Rocuronium (0.6?mg/kg). Patients were divided into 4 groups based on dosage of hydromorphone (n?=?20): group A (fentanyl, 5.0?μg/kg), group B (hydromorphone, 0.04?μg/kg), group C (hydromorphone, 0.06?μg/kg), group D (hydromorphone, 0.08?μg/kg). The heart rate (HR), systolic blood pressure (SBP), diastotolic blood pressure (DBP) and SpO2 were measured 5?min after entering the surgery room (T0), immediately after inserting tracheal catheter (T1), 1?min (T2), 3?min (T3) and 5?min (T4) after inserting tracheal catheter. The venous blood samples were taken at T0, T1, T2, T3, T4 time points for the measurements of epinephrine (AE), norepinephrine (NE) and dopamine (DA) with high performance liquid chromatography. Results Compared with T0, the HR at T1, T2, T3 in four groups were significantly increased (P?< 0.05), and the HR in group A at T4 was significantly higher than that at T0 (P??0.05). Conclusions Intravenous injection hydromorphone at 0.08 μg/kg is effective and safe, which reducing the hemodynamics and stress response during general anesthesia induction.