不同剂量的右美托咪啶抑制芬太尼诱发呛咳反应的临床研究  

Premedication with Different Doses of Dexmedetomidine Suppresses Fentanyl-induced Cough

作　　者：周婷[1] 王思桦[2] 武庆平[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院麻醉科,武汉430022 [2]华中科技大学同济医学院附属协和医院心血管外科,武汉430022

出　　处：《华中科技大学学报（医学版）》2013年第4期469-472,共4页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：国家自然科学基金资助项目(No.81070060)

摘　　要：目的观察和评价不同剂量右美托咪啶对预防麻醉诱导期间芬太尼诱发的呛咳反应的作用。方法全身麻醉气管插管下行择期手术患者280例,年龄18～65岁,体重45～80kg,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,每组70例,对照组(A组)输注生理盐水,不同剂量右美托咪啶组(B1组、B2组、B3组)分别于麻醉诱导前10min匀速持续静脉泵注右美托咪啶0.5、0.75、1.0μg/kg,泵注结束后4组均在3s内快速静脉推注芬太尼4μg/kg,观察麻醉诱导期间芬太尼诱发的呛咳反应发生率和严重程度、心率和血流动力学变化以及心血管不良事件的发生情况。结果 A组、B1组、B2组、B3组呛咳反应发生率分别为45.7%、34.2%、21.4%和18.6%,低血压发生率分别为28.5%、18.6%、10.0%、10.0%,心动过缓发生率分别为10.0%、12.9%、10.0%、27.1%。与A组比较B1组、B2组和B3组呛咳反应发生率显著降低(均P<0.01),B2组和B3组呛咳反应强度显著降低(均P<0.01),B3组严重窦性心动过缓发生率明显升高(P<0.01),B1组、B2组和B3组低血压的发生率显著降低(均P<0.01);与B1组比较,B2组和B3组呛咳反应发生率明显降低(均P<0.01),呛咳强度明显降低(均P<0.01)。结论静脉泵注右美托咪啶0.75μg/kg能够安全、有效预防芬太尼诱发的呛咳反应。Objective To investigate the efficacy of dexmedetomidine in preventing fentanyl-induced cough（FIC）during anesthesia induction.Methods A total of 280patients of ASAⅠorⅡ,aged 18-65years,weighing 45-80kg,were subjected to elective surgery and they were randomly divided into 4groups with 70patients in each group：A group in which the patients received normal saline,B1,B2and B3groups in which the patients received intravenous pump infusion of dexmedetomidine at 0.50,0.75or 1.0μg/kg,respectively,before anesthesia induction.Afterwards,all patients were intravenously given fentanyl（4 μg/kg）.Then,the incidence and severity of FIC were recorded.The adverse cardiovascular events were observed as well.Results In the A,B1,B2and B3groups,respectively,the incidence of FIC was 45.7%,34.2%,21.4% and 18.6%,the incidence of hypotension was 28.5%,18.6%,10.0%and 10.0%,and the incidence of bradycardia was 10.0%,12.9%,10.0%and 27.1%.Compared with the A group,the incidence of FIC was significantly decreased in B1to B3groups（P〈0.01for all）,the severity of FIC was significantly reduced in B2and B3groups（P0.01for both）,the incidence of bradycardia was substantially increased in the B3group（P〈0.01）,and the incidence of hypotension was dramatically reduced in B1,B2and B3groups（P 〈0.01for all）.Compared with the B1group,the incidence and severity of FIC were significantly reduced in B2and B3groups（P〈0.01for all）.Conclusion Intravenous pump infusion of dexmedetomidine at 0.75μg/kg could safely and effectively suppress FIC.

关 键 词：右美托咪啶 芬太尼 呛咳 麻醉诱导 

分 类 号：R614[医药卫生—麻醉学]