不同药物对芬太尼呛咳反应的抑制作用

The effect of lidocaine,ephedrine and salbutamol in suppressing fentanyl-induced cough

目的评价利多卡因、麻黄碱及沙丁胺醇抑制芬太尼呛咳反应的作用。方法选择100例ASAⅠ-Ⅱ级择期行全麻手术的女性患者,随机均分为4组。Ⅰ、Ⅱ、Ⅲ组分别于诱导前1min给予生理盐水2mL、利多卡因1.5mg/kg、麻黄碱5mg、Ⅳ组为沙丁胺醇组,全麻诱导前15min吸入沙丁胺醇200μg,各组全麻诱导均由外周静脉给予芬太尼4μg/kg、丙泊酚2mg/kg(0.5mL/s)、琥珀胆碱100mg。观察芬太尼呛咳的发生率和程度、诱导前后血流动力学的变化及相关并发症。结果各组呛咳的发生率分别为:Ⅰ组48%、Ⅱ组16%、Ⅲ组20%、Ⅳ组12%,与Ⅰ组比,Ⅱ、Ⅲ、Ⅳ组呛咳的发生率明显降低(P<0.05),但3个试验组间呛咳的发生率及强度并无明显差异。各组诱导前后血流动力学的变化一致。利多卡因组丙泊酚注射痛的发生率明显低于其他3组(P<0.01)。结论预注射1.5mg/kg的利多卡因、5mg的麻黄碱,及预吸入沙丁胺醇均能有效地减轻芬太尼引发的呛咳反应。由于利多卡因具有减少丙泊酚注射痛的优点,也许更值得推荐。

Purpose To evaluate the effectiveness of lidocaine, ephedrine and salbutamol in suppressing fentanyl-induced cough. Methods One hundred patients aged 20 - 60 years were randomly assigned into 4 groups and the following medications were given intravenously ： patients in Group Ⅰ （n = 25） received normal saline 2 mL, Group Ⅱ （n = 25） received lidocainel. 5 mg/kg, Group Ⅲ （n = 25） received ephedrine 5 mg, Group Ⅳ （n = 25） received an aerosol inhalation of salbutamol 15 min prior to induction of anesthesia. At 1 minute after the study medication, anesthesia was induced with intravenous fentanyl （4 μg/kg） ,propofol 2 mg/kg （0. 5 mL/s）and scoline 100 mg. The occurrence and severity of cough were recorded after fentanyl bolus. Heart rate and blood pressure（SBP, DBP）were measured before and after induction of anesthesia,and 1,3,6 min after intubation. Results The incidence of cough was 48 % in the control group, 16 %, 20 % and 12 % in lidocaine, ephedrine and salbutamol groups respectively. Occurrence of cough was significantly low （P〈 0. 05） in the treatment groups, however, the difference in the incidence and severity of cough among the groups was not significant （P〉 0. 05）. The changes of hemodynamics were consistent among the 4 groups. Group Ⅲ was found to have significantly less pain on the injection of propofol than other groups. Conclusions Intravenous lidocaine 1.5 mg/kg, ephedrine 5 mg 1 min or use of salbutamol aerosol 15 min prior to iv fentanyl administration is effective in preventing fentanyl-induced cough. Additionally, because of effectively preventing the pain on the injection of propofol, lidocaine is more worth to be recommended.