盐酸纳美芬对小儿手术全麻诱导时舒芬太尼诱发呛咳反应的预防研究

Study on nalmefene hydrochloride in preventing choking cough reaction induced by sufentanil during induction of general anesthesia in children undergoing surgery

目的探讨盐酸纳美芬对预防小儿手术全麻诱导时舒芬太尼诱发呛咳反应的作用。方法选取2021年6月至2022年3月在我院行双侧或单侧疝气及鞘膜积液的腹腔镜手术患儿150例作为研究对象,随机分为观察组和对照组各75例。观察组在手术全麻诱导前1 min给予0.25μg/kg盐酸纳美芬,对照组则给予等量生理盐水。观察两组患儿注射舒芬太尼后1 min内的呛咳次数,5、10、15和20 min内心率、血氧饱和度、平均动脉压和脑点双频指数等生命体征和不良反应情况。结果观察组呛咳总发生率为0%(0/75),低于对照组33.3%(25/75),控制良好率为100%(75/75),高于对照组66.7%(50/75),差异有统计学意义(P<0.05)。两组患儿5 min、10 min和20 min时的收缩压、舒张压、平均动脉压、心率、血氧饱和度和脑点双频指数比较差异无统计学意义(P>0.05)。15 min时观察组的收缩压和脑点双频指数低于对照组,差异有统计学意义(P<0.05),两组患儿舒张压、平均动脉压、心率、血氧饱和度比较差异无统计学意义(P>0.05)。观察组不良反应发生率为1.3%(1/75),对照组为4.0%(3/75),两组患儿不良反应发生率比较差异无统计学意义(P>0.05)。结论入室后麻醉诱导前1 min给予0.25μg/kg盐酸纳美芬可有效预防小儿手术全麻诱导时舒芬太尼诱发的呛咳,且不影响血流动力学,也不增加药物不良反应,可安全用于临床。

Objective To study the effect of nalmefene hydrochloride in the prevention of sufentanil-induced choking cough reaction during general anesthesia induction in children undergoing surgery.Methods Today 150 children,who underwent laparoscopic surgery for bilateral or unilateral hernia and hydrocele in our hospital from June 2021 to March 2022,were selected as the study subjects,and were randomly divided into an observation group and a control group with 75 cases each.The observation group was given 0.25μg/kg nalmefene hydrochloride one minute before general anesthesia induction,while the control group was given the same amount of normal saline.The frequency of choking cough within one minute after injection of sufentanil,the vital signs of heart rate(HR),blood oxygen saturation(SpO 2),mean arterial pressure(MAP),bispectral index(BIS)at 5,10,15 and 20 minutes and other adverse reactions were observed in the two groups.Results The observation group had lower incidence of choking cough(0%,0/75)and better control rate(100%,75/75)than the control group[33.3%(25/75)and 66.7%(50/75)],and the difference had statistical significance(P<0.05).However,no obvious difference was found in SBP,DBP,MAP,HR,SpO 2 or BIS between the two groups at 5min,10min and 20min(P>0.05).At 15min,SBP and BIS in the observation group were lower than those in the control group(P<0.05).No significant difference was found in DBP,MAP,HR or SpO 2 between the two groups(P>0.05).There was no significant difference in the incidence of adverse reactions between the two groups[4.0%(3/75)in control group vs 1.3%(1/75)in observation group].Conclusion The administration of 0.25μg/kg nalmefene hydrochloride one minute before anesthesia induction after entering the operation room can effectively prevent the sufentanil-induced choking cough reaction during general anesthesia in children,which does not affect the hemodynamics or increase the adverse drug reactions,so it can be safely used in clinic.