摘要
目的观察右美托咪定预防芬太尼诱发呛咳反应的临床效果。方法择期全身麻醉(全麻)手术患者120例随机分为三组,每组40例。麻醉诱导前,D组10 min内静脉输注右美托咪定0.4μg/kg,K组雾化吸入氯胺酮0.25 mg/kg(用生理盐水稀释至4 ml),C组雾化吸入生理盐水4 ml。各组给药结束5 min后,5 s内静脉注射芬太尼3μg/kg,记录芬太尼诱发呛咳反应的发生情况,评估警觉/镇静(OAA/S)评分。其后行常规麻醉诱导和气管插管,记录麻醉前(T0)、预给药结束5 min后(T1)、气管插管前即刻(T2)、气管插管后即刻(T3)、气管插管后1 min(T4)和气管插管后3 min(T5)时的SBP、DBP和HR变化。结果D、K组芬太尼诱发呛咳的发生率相仿(12.5%vs.10.0%)(P>0.05),但均低于C组的40.0%(P<0.05)。三组T0和T1时OAA/S评分均为5分。与T0时比较,三组T2时SBP和DBP均降低,HR减慢(P<0.05);D组T1、T3~T5时SBP、DBP和HR变化较K、C组更为明显(P<0.05)。结论全麻诱导前静脉输注右美托咪定或雾化吸入氯胺酮均可有效减轻芬太尼诱发呛咳反应的发生;与雾化吸入氯胺酮比较,预先静脉输注右美托咪定更能有效减轻气管插管应激反应,维持全麻诱导期循环稳定。
Objective To observe the clinical efficacy of dexmedetomidine in attenuating fentanyl-induced cough response during induction of general anesthesia.Methods A total of 120 patients undergoing selective surgery under general anesthesia was randomly divided into three groups with 40 cases each.Dexmedetomidine 0.4μg/kg was intravenous infused in 10 minutes in group D before anesthesia induction.Before anesthesia induction,the nebulized inhalation of ketamine 0.25 mg/kg in normal saline 4 ml was performed in group K and the nebulized inhalation of normal saline 4 ml was carried out in group C.At 5 minutes after the end of dexmedetomidine infusion of group D,ketamine nebulization of group K or normal saline nebulization of group C,fentanyl 3μg/kg was intravenously injected within 5 seconds.The occurrence of cough induced by fentanyl was recorded and the vigilance/sedation(OAA/S)score was assessed.After that,the routine anesthesia induction and endotracheal intubation were performed and the changes of SBP,DBP and HR before anesthesia(T0),at 5 minutes after the end of pre-administration(T1),immediately before endotracheal intubation(T2),immediately after endotracheal intubation(T3)and at 1(T4)and 5(T5)minutes after endotracheal intubation were recorded.Results The incidence of cough induced by fentanyl in groups of D and K was similar(12.5%vs.10.0%),which was significantly lower than 40.0%in group C(P<0.05).OAA/S scores were 5 points at T0 and T1 in the three groups.Compared to T0,SBP and DBP were lower and HR was slower at T2 in groups of C,D and K(P<0.05),which were more in group D than those in groups of K and C at T1 and T3-T5(P<0.05).Conclusion Both of intravenous infusion of dexmetomidine and nebulized inhalation of ketamine before induction of general anesthesia can effectively reduce the occurrence of cough response induced by fentanyl injection,the former is better in attenuating the stress response to tracheal intubation and maintaining the stability of circulation.
作者
徐巧芳
卞清明
刘辉
XU Qiaofang;BIAN Qingming;LIU Hui(Department of Anesthesiology,Jiangsu Cancer Hospital,Nanjing 210009,CHINA)
出处
《江苏医药》
CAS
2019年第11期1156-1158,共3页
Jiangsu Medical Journal
关键词
右美托咪定
氯胺酮
雾化吸入
芬太尼诱发呛咳
Dexmedetomidine
Ketamine
Nebulized inhalation
Fentanyl-induced cough
