羟考酮与氯胺酮抑制芬太尼诱发咳嗽的效果比较  

Comparison the effective of oxycodone and ketamine in fentanyl-induced cough

作　　者：张庆伟[1] 王忠云[1] 孙合亮 Zhang Qingwei;Wang Zhongyun;Sun Heliang(Department of Anesthesiology,Jiangsu provincial people' s hospital,Nanjing,Jiangsu,210029,China)

机构地区：[1]江苏省人民医院麻醉科,江苏南京210029

出　　处：《当代医学》2019年第13期114-116,共3页Contemporary Medicine

摘　　要：目的比较全麻诱导前预先静注羟考酮或氯胺酮对芬太尼诱发咳嗽的抑制效果。方法 180例全麻下行择期妇科腔镜手术的患者随机均分成羟考酮组、氯胺酮组和生理盐水组。3组患者在芬太尼3μg/kg(3 s内注射完毕)注射前5 min分别注射羟考酮0.1 mg/kg、氯胺酮0.2 mg/kg或等量生理盐水(3组均在3 s内注射完毕)。记录芬太尼注射后2 min内咳嗽的发生次数、严重程度以及第一次咳嗽出现的时间。根据咳嗽的次数将咳嗽的严重程度分为3级(轻度:1～2次;中度:3～5次;重度:>5次)。分别在羟考酮、氯胺酮或生理盐水注射前(T_0)和芬太尼注射后2 min(T_1)记录患者的HR、SpO_2、MAP。结果羟考酮组和氯胺酮组患者咳嗽的发生率明显低于生理盐水组(8.3%vs 20%vs41.7%,P<0.05);羟考酮组咳嗽的发生率明显低于氯胺酮组(8.3%vs 20%,P<0.05);羟考酮组和氯胺酮组在咳嗽严重程度以及第一次咳嗽的出现时间与生理盐水组比较差异具有统计学意义(P<0.05),但羟考酮和氯胺酮组比较差异无统计学意义。结论预注羟考酮0.1 mg/kg或氯胺酮0.2 mg/kg均能有效减少全麻诱导时芬太尼诱发的咳嗽,且羟考酮的抑制效果更好。Objective To compare the effects of pre-injection of oxycodone or ketamine in fentanyl-induced cough before induction of general anesthesia. Methods 180 patients undergoing elective gynecologic laparoscopic surgery under general anesthesia were randomly divided into oxycodone group, ketamine group and Saline group. The patients of three groups were received oxycodone 0.1 mg/kg, ketamine 0.2 mg/kg or the equal volume of 0.9% saline 5 min before fentanyl 3 μg/kg injection (bolus within 3 s). The number and severity of coughs and the time of first cough occurred within 2 minutes after fentanyl injection were recorded. The severity of cough was divided into three levels according to the number of coughs,(mild: 1-2 times;moderate: 3-5 times;severe:>5 times). HR, SpO2, and MAP of the patients were recorded at the time before oxycodone, ketamine or saline injection (T0) and 2 minutes (T1) after fentanyl injection. Results The incidence of cough in the oxycodone group and ketamine group was significantly lower than in the saline group (8.3% vs 20% vs 41.7%, P<0.05). The incidence of cough in the oxycodone group was significantly lower than in the ketamine group (8.3% vs 20%, P<0.05). The severity of cough and the time of first cough were significantly different in the oxycodone and ketamine groups compared with the saline group (P<0.05), but there was no difference between the oxycodone and ketamine groups. Conclusion Pre-injection of oxycodone 0.1 mg/kg or ketamine 0.2 mg/kg can effectively reduce the fentanyl-induced cough during general anesthesia, and the effect of oxycodone is better than ketamine.

关 键 词：羟考酮 芬太尼 氯胺酮 咳嗽 

分 类 号：R614[医药卫生—麻醉学]