麻醉诱导时芬太尼不同给药方法对其诱发患者咳嗽的影响  

Effects of different medications of fentanyl during anesthesia induction on fentanyl-induced cough

作　　者：丁超[1] 孙莉[1] 张燕[1] 王海[1] 承耀中[1] 赵桂军[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院麻醉科,100021

出　　处：《中华麻醉学杂志》2011年第9期1073-1075,共3页Chinese Journal of Anesthesiology

摘　　要：目的评价麻醉诱导时芬太尼不同给药方法对其诱发患者咳嗽的影响。方法择期全麻手术患者420例，年龄18。60岁，性别不限，ASA分级Ⅰ或Ⅱ级，采用随机数字表法，将患者随机分为4组（n=105）：常规组（Ⅰ组）、预注射组（Ⅱ组）、稀释组（Ⅲ组）和后注射组（Ⅳ组）。麻醉诱导：Ⅰ组依次静脉注射咪达唑仑0．05mg／kg、芬太尼（50μg／m1）2μg／kg、异丙酚2mg／kg、罗库溴铵1mg／kg；Ⅱ组依次静脉注射咪达唑仑0．05mg／kg、芬太尼（50μg／m1）0．5μg／kg、异丙酚2mg／kg、罗库溴铵1mg／kg、芬太尼（50μg／m1）1．5μg／kg；m组依次静脉注射咪达唑仑0．05mg／kg、芬太尼（20btg／m1）2μg／kg、异丙酚2mg／kg、罗库溴铵1mg／kg；Ⅳ组依次静脉注射咪达唑仑0．05mg／kg、异丙酚2mg／kg、罗库溴铵1mg／kg、芬太尼（50μg／m1）2μg／kg。注药完毕后2min行气管插管。气管插管前观察咳嗽、异丙酚注射痛的发生情况，于麻醉诱导前、诱导后、咳嗽时、气管插管时记录HR和有创动脉压。结果与Ⅰ组比较，其余组患者咳嗽发生率和咳嗽程度降低（P〈0．05）；与Ⅱ组和Ⅲ组比较，Ⅳ组患者咳嗽发生率和咳嗽程度降低（P〈0．05）。四组其余指标组间比较差异无统计学意义（P〉0．05）。结论麻醉诱导时芬太尼稀释给药、给予预注剂量或后注射均可明显降低其诱发咳嗽的发生，其中后注射效果最佳。Objective To compare the effects of different medications of fentanyl during anesthesia induction on fentanyl-induced cough.Methods Four hundred and twenty ASA Ⅰ or Ⅱpatients aged 18-60 yr undergoing selective operations under general anesthesia, were randomly divided into 4 groups （ n = 105 each） ： group Ⅰ （control group） received successive intravenous injection of midazolam 0.05 mg/kg, fentanyl 2 t.tg/kg, propofol 2 mg/kg, and rocuronium 1 mg/kg, group Ⅱ （pre-injection group） received successive intravenous injection of midazolam 0.05 mg/kg, fentanyl 0.5 /tg/kg, propofol 2 mg/kg, rocuronium 1 mg/kg, and fentanyl 1.5 /xg/kg, group Ⅲ （dilution group） received successive intravenous injection of midazolam 0.05 mg/kg, fentanyl 2 μg/kg （20μg/ml）, propofol 2 mg/kg, and rocuronium 1 mg/kg, and group IV （last injection group） received successive intravenous injection of midazolam 0.05 mg/kg, propofol 2 mg/kg, rocuronium 1 mg/kg, and fentanyl 2 μg/kg. Fentanyl concentration was 50μg/ml in each group except group m Endotracheal intubation was performed 2 min after anesthesia induction. The incidence and severity of fentanyl-induced cough before intubation were recorded and the incidence of propofol-induced pain was recorded. Invasive arterial blood pressure （ABP） and heart rate （HR） were observed before induction （T1）, immediately after induction （T2）, at time of coughing （T3）, and at time of eudotracheal intubation （T4） , Results ABP and HR had no significant differences at Tl , T2, T3 , and T4 between the four groups （P 〉 0.05）. The incidence of propofol-induced pain had no significant differences between the four groups （P 〉 0.05）. The incidences of cough was 7.6% in group Ⅱ , 9.5% in group m , and 1.9 % in group Ⅳ, which were significantly lower than 35.2 % in group Ⅰ （ P 〈 0.01 ）. The incidence of cough in group Ⅳwas significantly lower than that in groupsⅡ and Ⅲ/ （P 〈 0.05）.In the four groups, ABP and HR were signi

关 键 词：芬太尼 咳嗽 麻醉 

分 类 号：R614[医药卫生—麻醉学]