氢吗啡酮预处理对依托咪酯所致肌阵挛的影响

目的观察氢吗啡酮预处理对依托咪酯全麻诱导时所致肌阵挛的影响。方法选择2017年12月至2018年12月180例在全麻下行择期手术的患者,ASAⅠ~Ⅱ级,年龄18~60岁,采用分层随机化分为3组,各组60例。Ⅰ组静脉注射氢吗啡酮5μg/kg,Ⅱ组静脉注射舒芬太尼0.1μg/kg,Ⅲ组静脉注射同等容积的0.9%氯化钠溶液,观察并记录有无呼吸抑制、皮肤瘙痒、恶心、呕吐、呛咳等不良反应。5 min后静脉注射依托咪酯0.3 mg/kg,观察并记录3组患者肌阵挛的程度和发生率。2 min后给予咪达唑仑0.05 mg/kg,Ⅰ组和Ⅱ组予舒芬太尼0.3μg/kg,Ⅲ组予舒芬太尼0.4μg/kg,顺式阿曲库胺0.15 mg/kg后行气管插管。结果Ⅰ组患者有2例发生轻度肌阵挛;Ⅱ组患者4例发生轻度肌阵挛和1例中度肌阵挛,Ⅲ组患者有32例发生肌阵挛,其中轻度12例,中度13例,重度7例。3组患者预处理期间均未发生呼吸抑制、呛咳、皮肤瘙痒及恶心呕吐等不良反应。结论预注5μg/kg氢吗啡酮可明显降低依托咪酯所致肌阵挛的发生率和程度,且无呼吸抑制、恶心、呕吐、皮肤瘙痒等不良反应发生。

Effect of hydromorphone pretreatment on myoclonus induced by etomidate

Objective To observe the effect of hydromorphone pretreatment on myoclonus induced by etomidate general anesthesia.Methods A total of 180 patients undergoing elective surgery under general anesthesia from December 2017 to December 2018,ASAⅠtoⅡ,aged 18 to 60 years old,were divided into 3 groups by stratified randomization,with 60 cases in each group.GroupⅠreceived intravenous injection of hydromorphone 5μg/kg,groupⅡreceived intravenous injection of sufentanil 0.1μg/kg,and groupⅢinjected the same volume of 0.9%sodium chloride solution intravenously.Observe and record whether there is respiratory depression,skin itching,and nausea.Vomiting,coughing and other adverse reactions.Etomidate 0.3 mg/kg was intravenously injected 5 minutes later,and the degree and incidence of myoclonus were observed and recorded in the 3 groups.Two minutes later,midazolam was given 0.05 mg/kg,groupsⅠandⅡwere given sufentanil 0.3μg/kg,groupⅢwas given sufentanil 0.4μg/kg and cis-atracuramide 0.15 mg/kg Line tracheal intubation.Results 2 patients in groupⅠhad mild myoclonus,4 patients in groupⅡhad mild myoclonus and 1 had moderate myoclonus,and 32 patients in groupⅢhad myoclonus,of which 12 had mild myoclonus,13 cases were moderate,7 cases were severe.There were no adverse reactions such as respiratory depression,coughing,skin itching,nausea and vomiting in the three groups of patients during pretreatment.Conclusion Pre-injection of 5μg/kg hydromorphone can significantly reduce the incidence and degree of myoclonus caused by etomidate,and there is no adverse reactions such as respiratory depression,nausea,vomiting,and skin itching.