马玉恒 刘中光 李永旺 张树峰 刘帆 韩月鹏 陈阳

[摘要] 目的 观察不同剂量的盐酸羟考酮预处理对依托咪酯全麻诱导时肌阵挛的影响。 方法 选择2014年5月～2015年1月于第二炮兵总医院择期全麻手术患者120例，将其随机分为A、B、C、D四组，每组各30例。A组患者于麻醉诱导前5 min静脉注射生理盐水5 mL作为对照组，B、C、D三试验组患者麻醉诱导前5 min分别静脉注射盐酸羟考酮注射液0.04、0.08、0.12 mg/kg（均用生理盐水稀释到5 mL）预处理。观察并记录各组患者发生呼吸抑制的情况，5 min后，四组患者均给予依托咪酯脂肪乳0.25 mg/kg（注射时间为30 s）进行麻醉诱导，观察各组患者给予依托咪酯后有无肌阵挛发生。 结果 A组患者发生肌阵挛的总数为12例（40.0%），B组8例（26.7%），C组2例（6.7%），D组1例（3.3%）；其中，B组与C、D两组患者比较差异均有统计学意义（P < 0.05），C组与D组比较差异无统计学意义（P > 0.05）。A组患者均未出现呼吸抑制，B组发生呼吸抑制2例（6.7%），C组4例（13.3%），D组12例（40.0%）；其中，B、C两组与D组患者比较差异均有统计学意义（P < 0.05），B、C两组比较差异无统计学意义（P > 0.05）。 结论 盐酸羟考酮预处理可减少依托咪酯全麻诱导时肌阵挛的发生率，其剂量为0.08 mg/kg时效果好且呼吸抑制程度较轻。

[关键词] 盐酸羟考酮；依托咪酯；肌阵挛；麻醉诱导

[中图分类号] R971.2 [文献标识码] A [文章编号] 1673-7210（2015）06（a）-0124-04

Effect of oxycodone hydrochloride pretreatment on Myoclonus induced by Etomidate

MA Yuheng▲ LIU Zhongguang▲ LI Yongwang ZHANG Shufeng LIU Fan HAN Yuepeng CHEN Yang

Operation Center of Cerebral Vascular Disease Research Institute， the Second Artillery General Hospital， Beijing 100088， China

[Abstract] Objective To observe the effects of myoclonus under different doses of oxycodone hydrochloride injection pretreatment on the induction of anesthesia with Etomidate. Methods A total of 120 cases from May 2014 to January 2015 undergoing genenal anesthesia in the Second Artillery General Hospital were randomly divided into four groups of A， B， C and D， 30 cases in each group. Group A， the control group， was given intravenously 5 mL normal saline 5 minutes before induction of anesthesia； groups B， C and D were given 5 mL of pretreatment of oxycodone hydrochloride （in which the dose was respectively set as 0.04， 0.08， 0.12 mg/kg） 5 minutes before induction of anesthesia， the situationin of respiratory depression was recorded in the four groups. And then， patients of the four groups were given anesthesia of Etomidate fat emulsion of 0.25 mg/kg （in 30 seconds）， the situationin of myoclonus in the four groups was observed. Results 12 patients （40.0%） occurred myoclonus in group A， the number of group B was 8 （26.7%）， group C was 2 （6.7%）， group D was 1 （3.3%）. Among of them， group C and D were significantly different from group B （P < 0.05）， there was no statistically significant difference between group C and group D （P > 0.05）. None of patients occurred respiratory depression in group A， the number of patients with respiratory depression in group B was 2 （6.7%）， group C was 4 （13.3%）， group D was 12 （40.0%）. Group B and C were significantly different from group D （P < 0.05）， there was no statistically significant difference between group B and group C （P > 0.05）. Conclusion Myoclonus induced by Etomidate in induction of anesthesia can be prevented by pretreatment of oxycodone hydrochloride， with 0.08 mg/kg being the optimal dose.

[Key words] Oxycodone； Elomidate； Myoclonus； Induction of anesthesia

依托咪酯是一种超短时效的非巴比妥类催眠性静脉麻醉药，它具有麻醉效能强、起效快、诱导平稳、舒适、对呼吸、循环影响轻微等优点，尤其适用于休克、心功能不全、高龄等患者的全麻诱导，已成为复合全麻的常用药物之一。但是，依托咪酯用于麻醉诱导时易产生肌阵挛，这不仅使依托咪酯丧失循环稳定性的优点，还可导致其它不良后果。……