目的：比较盐酸羟考酮与芬太尼分别复合丙泊酚对喉显微手术的麻醉效果。方法：喉显微手术患者120例，年龄22～65岁，体重42～85 kg，ASA分级Ⅰ～Ⅱ级，随机均分2组（n=60例）。所有病人均采用全凭静脉麻醉。常规去氮给氧依次静注丙泊酚2.0 mg·kg-1+芬太尼3.0μg· kg-1（F组）或丙泊酚2.0 mg·kg-1盐酸羟考酮0.1 mg·kg-1（O组），以1.0 mL·s-1的速率静脉推注芬太尼或盐酸羟考酮后，观察1 min内患者的呛咳反应，然后再给予米库氯胺2.0 mg·kg-1，待肌松完全后行气管插管。记录入室前（T0）、静注芬太尼或盐酸羟考酮后1 min（T1）、插管后1 min（T2）、插管后5 min（T3）、拔管后3 min（T4），记录平均动脉压（MAP）、心率（HR）并采集静脉血用放免法检测皮质醇（Cor）、用高效液相色谱-电化学法测定去甲肾上腺素（NE）、用己糖激酶法测定血糖（Glu），同时记录麻醉诱导时两组患者呛咳反应（FIC）发生率；麻醉苏醒和离开手术室时间及恶心呕吐、呛咳躁动、咽喉疼痛、呼吸抑制等不良反应发生率。结果：F组、O组在T2、T3、T4时点NE、Cor、Glu、MAP、HR虽有所升高，但与T0相比，差异无统计学意义（P＞0.05）；在T1时点，F组MAP明显升高、HR明显加快，NE、Cor、Glu分泌水平也明显增加，O组T0与T1时点相比，差异有明显的统计学意义（P＜0.05）；F 组患者FIC 的发生率18例（30%）明显高于O 组的0例（P＜0.05）；术后呼吸抑制F组发生率6例（10%）明显高于O组的1例（1.7%）（P＜0.05）；恶心、呕吐发生率F组10例（16.7%）明显高于O组的2例（3.3%）（P＜0.05）；两组清醒时间、离开手术室时间差异无统计学意义；两组咽喉疼痛、苏醒期呛咳躁动等不良反应发生率差异无统计学意义（P＞0.05）。结论：盐酸羟考酮（0.1 mg·kg-1）作为全麻诱导辅助药可以增强心血管稳定性、降低围手术期的应激反应，避免FIC的发生，降低了不良反应的发生。%Objective: To compare the anesthetic efficacy of oxycodone hydrochloride or fentanyl com-pounding propofol in patients with laryngeal microsurgery anaesthesia. Methods: One hundred and twenty patients (aged 22 to 65 years old, weighing 42-85 kg, ASA grade I-II) were randomly divided into 2 groups (n=60), all patients underwent total intravenous anesthesia. Routine preoxygenation was followed by intra-venous injection of propofol 2.0 mg·kg-1 and fentanyl 3.0μg·kg-1 (group F) or oxycodone hydrochloride 0.1 mg·kg-1 (group O), at a rate of 1.0 mL·s-1. Cough reaction (FIC) was observed for 1 min, and then patients were given mivacurium chloramine 2.0 mg·kg-1 and intubated after their muscles were relaxed completely. At the time points of T0 (entering the room), T1 (1 min after fentanyl or oxycodone hydrochloride injection), T2 (1 min after intubation), T3 (5 mins after intubation) and T4 (3 mins after extubation), HR, MAP and cough incidence were recorded. Meanwhile, blood cortisol (Cor), NE and glucose (Glu) levels were detected by ra-dioimmunoassay, high performance liquid chromatography and hexokinase assay, respectively. Further, anes-thesia time, anesthesia recovery time, nausea and vomiting, sore throat, respiratory depression and other ad-verse effects were also recorded. Results: At T2, T3 and T4, the values of NE, Cor, Glu, MAP and HR had slight increase in group F and group O, but did not show any significant difference with those of the same group at T0 (P>0.05); And at T1, NE, Cor, Glu, MAP and HR significantly increased in group F compared with those in group O. The incidence of FIC in group F (18 cases) was much higher than that in group O (0). The Adverse incidents in group F were more than those in group O, such as respiratory depression, nausea and vomiting, but the waking time and leaving surgery room time in these two groups did not show any statistically significant difference (P>0.05). Conclusion: As an induction adjuvant in general anesthesia, oxycodone hydrochloride (0.1 mg·kg-1) can enhance the cardiovascular stability, reduce the stress response during operation period, avoid the occurrence of FIC and reduce the incidence of adverse reactions.
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