预注地佐辛抑制芬太尼呛咳反射半数有效量的测定  

The median effective dose of pre -injection Dezocine before induction of anesthesia for suppresses fentanyl cough reflex

作　　者：洪锦才 冯作炫[2] 

机构地区：[1]福建省漳州市中医院麻醉科,福建漳州363000 [2]福建省宁德市医院麻醉科,福建宁德352100

出　　处：《中国当代医药》2013年第7期72-73,75,共3页China Modern Medicine

基　　金：福建省卫生厅青年基金资助课题(编号:2007-2-43)

摘　　要：目的探讨麻醉诱导前预注地佐辛抑制芬太尼呛咳反射的可行性及其半数有效剂量。方法选择本院2012年1-9月拟择期全麻行手术患者30例，年龄25～50岁，ASAⅠ～Ⅱ级，采用Dixon序贯法，即第一例患者在麻醉诱导前预注地佐辛剂量为0．05mg／kg，10rain后，于3s内快速给予芬太尼0．003mg／kg进行麻醉诱导，观察1min，如果该患者出现呛咳反射，则下一例患者地佐辛剂量增加0．01mg／kg，直至呛咳反射被抑制，反之则减少0．01mg／kg，直至患者出现呛咳反射，同时监测患者入室时（T1），预注地佐辛后10min（T2），快速推注芬太尼诱导后1min（T3）平均动脉压（MAP）、心率（HR）、血氧饱合度（SpO：）值，采用Dixon序贯法计算地佐辛抑制芬太尼呛咳反射ED50。结果不同剂量地佐辛抑制芬太尼呛咳反应中未出现呛咳反射的患者数分别为：0．04mg／kg时1例，0．05mg／kg时为2例，0．06mg／kg时为10例，0．07mg／kg时所有患者均未见呛咳反应。采用Dixon序贯法计算得到的地佐辛抑制芬太尼呛咳反射的ED50为0．053mg/kg（95％CI：0．058—0．048），其中，呛咳反射组患者芬太尼诱导后1minMAP、HR明显升高（P〈0．05），而Sp02则无明显改变。结论通过预注地佐辛可明显降低芬太尼快速诱导所致呛咳反射。并能减轻心血管应激反应。Objective To explore the feasibility and median effective dose of the pre-injection Dezocine before induction of anesthesia for suppresses fentanyl cough reflex. Methods Thirty ASAI-II, aged 25 to 50 years old patients, undergoing elective surgery through general anesthesia were enrolled during January 2012 and September 2012 in our hospital, Dixon＇s up-and-down method was used in this study, that the first patients was priming injected 0.05 mg/kg Dezocine before induction of anesthesia, and then after 10 minutes, fast injectde fentanyl 0.003 mg/kg within 3 seconds, if the patient appears to cough reflex within 1 minute, the next one case should be increasded 0.01 mg/kg of Dezocine dose, until the cough reflex was suppressed, or otherwise reduce 0.01mg/kg until the patients appeared cough reflex. The time after the patients in the operating room （T1）, afte pre-injection Dezocine 10 minute（T2）, after quickly injeered fentanyl-induced 1 minute （T3）, the MMAP, HR, SpQ was monitored. Results The numbers of patients didn＇t appear cough when pre-injection Dezocine for suppress fentanyl cough reflex were： 0.04 mg/kg for one patient, 0.05 mg/kg for two patients, 0.06 mg/kg for ten patients, and 0.07 mg/kg for nobody. The ED50 of the Dezocine supressed fentanyl cough reflex was 0.053 mg/kg （95%CI：0.058-0.048） with Dixon sequential manner. After quickly injected fentanyl-induced 1 minute, the MAP, HR obviously increased （P 〈 0.05） in the cough group, while SPO2 no significantly changed. Conclusion By pre-injection Dezocine can significantly reduce fentanyl-induction cough reflex, and also can reduce cardiovascular stress response.

关 键 词：地佐辛 芬太尼 呛咳 麻醉诱导 

分 类 号：R614[医药卫生—麻醉学]