利多卡因对先心病小儿芬太尼麻醉诱发呛咳的预防作用

Prevention of fentanyl-induced cough by lidocaine pretreatment in children with congenital heart diseases

目的研究利多卡因预处理对于先天性心脏病小儿芬太尼麻醉诱发呛咳的预防作用及安全性。方法540例先天性心脏病择期手术患儿，ASAⅡ—Ⅲ级，年龄1月-14岁，体质量4—65kg。患儿随机分成9组（n=60），分别按照正交实验设计表（L9 3^4）接受利多卡因预处理，安排四因素各三水平分别给药。结果经利多卡因1．5mg／kg预处理后，芬太尼麻醉诱发的呛咳发生率最低，为56．1％。首剂芬太尼以5、7．5和10μg／kg诱导，呛咳发生率分别为55．0％、66．1％和72．2％；以10、20、30s推注芬太尼，呛咳发生率分别为75．0％、68．9％、49．4％。结论利多卡因1．5mg／kg预处理，在30S内缓慢静注首剂芬太尼5μg／kg，是先心病小儿芬太尼麻醉诱导时减轻呛咳反应较好的处理方案。

Objective To investigate the effectiveness and safety of lidocaine pretreatment on prevention of fentanylinduced cough in children with congenital heart diseases. Methods Five hundred and forty patients with congenital heart diseases who were to undergo selective operation were enrolled, with Ⅱ-Ⅲ in ASA grading, 1 month to 14 years in age and 4 to 65 kg in weight. All the patients were randomly divided into 9 groups（n =60）. Lidocaine was administered to patients according to the orthogonal design （ L9 3^4 ）. Results When pretreated with 1. 5 mg/kg lidocaine, the incidence of fentanyl-induced cough was the lowest （56.1%）. 5, 7.5 and 10 μg/kg as first doses, the incidences of fentanyl-induced cough were 55.0% , 66.1% and 72.2% , respectively. With intravenous fentanyl boluses in 10, 20 and 30 s, the cough incidences were 75.0% , 68.9% and 49.4% , respectively. Conclusion Pretreatment with 1. 5 mg/kg lidocaine, 5 μg/kg fentanyl injection at a lower speed within 30 s as first dose, fentanyl-induced cough can be effectively alleviated in children with congenital heart diseases.