等效剂量芬太尼、舒芬太尼和雷米芬太尼诱发咳嗽的比较

Comparison of cough induced by equivalent doses of fentanyl,sufentanil,and remifentanil

目的比较等效剂量芬太尼、舒芬太尼和雷米芬太尼诱发咳嗽的发生率和严重程度。方法 315例ASAⅠ或Ⅱ级患者随机均分为三组,分别在5s内注入芬太尼2μg/kg(芬太尼组)、舒芬太尼0.2μg/kg(舒芬太尼组)、雷米芬太尼2μg/kg(雷米芬太尼组)。观察注药后2min内咳嗽的发生率及严重程度、SpO2及咳嗽患者的SBP和HR变化。结果雷米芬太尼组咳嗽的发生率为54.3%,明显高于芬太尼组的33.3%和舒芬太尼组的30.5%(P<0.01);雷米芬太尼组咳嗽的程度比芬太尼组和舒芬太尼组严重(P<0.01)。咳嗽患者的SBP从基础值(128±12)mmHg升高至(139±16)mmHg(P<0.01),HR从基础值(74±10)次/分增快至(87±16)次/分(P<0.01)。给药2min内,59%的雷米芬太尼组患者因低氧血症(SpO2<90%)需面罩辅助通气,而芬太尼组和舒芬太尼组患者未发生低氧血症。结论与等效剂量的芬太尼或舒芬太尼相比,雷米芬太尼诱发咳嗽的发生率更高,程度更严重。

Objective To compare the incidence and severity of cough induced by equivalent doses of fentanyl, sufentanil, and remifentanil. Methods A total of 315 patients with ASA Ior Ⅱ were randomized into 3 groups （n= 105） to receive equivalent doses of fentanyl （2 ug/kg, fentanyl group）, sufentanil （0. 2 ug/kg, sufentanil group）, or remifentanil （2 ug/kg, remifemanil group） via Ⅳ push within 5 seconds, respectively. The incidence and severity of cough, pulse oxygen saturation （SpOe）, and systolic blood pressure （SBP）, heart rate （HR） in patients with cough were observed for 2 minutes after drug administration. Results Remifentanil group had a higher incidence of cough （54. 3%） than fentanyl （33. 3%, P〈0. 01） and sufentanil groups （30. 5%, P〈0.01）. The cough was severer in remifentanil group than those in fentanyl and sufentanil groups （P〈0. 01）. SBP increased from （128±12） to （139±16） mm Hg, and HR from （74±10） to （87±16） beats/min in patients with cough （P〈0. 01）. Within 2 minutes after drug administration, 59% of patients in remifentanil group experienced hypoxemia （SpO2 90%） necessitating manually assisted mask ventilation, while no patients experienced hypoxemia in fentanyl and sufentanil groups. Conclusion Remifentanil induces a higher incidence and more severity of cough than equivalent doses of fentanyl and sufentanil.