不同剂量右美托咪啶预防舒芬太尼诱发患者全麻诱导期间呛咳反应的可行性

Feasibility of different doses of dexmedetorxidine required to prevent sufentanil-induced cough during anesthesia induction

目的评价不同剂量右美托咪啶预防舒芬太尼诱发患者麻醉诱导期间呛咳反应的可行性。方法择期拟行全麻下妇科手术患看240例，年龄18—55岁，体重45—78kg，ASA分级Ⅰ或Ⅱ级。采用随机数字表法，将患者随机分为4组（n=60）：对照组（c组）不输注右美托咪啶；不同剂量右美托咪啶组（D1组、耽组、D3组）分别于麻醉诱导前静脉输注右美托咪啶0．10、0．25和0．50μg／kg，输注速率均为0．05μg·kg^-1-min^-1。麻醉诱导：靶控输注异丙酚（效应室靶浓度5μg／m1）至BIS值达55时，静脉注射舒芬太尼0．5μg／kg，注射时间3s。记录舒芬太尼注射后1min内呛咳反应的发生情况及程度。观察结束后静脉注射琥珀胆碱1～2mg／kg诱导气管插管，记录开始静脉输注右美托咪啶至气管插管后1min内心血管不良事件的发生情况。结果c组、DI组、D2组和D，组呛咳反应发生率分别为25％、7％、7％和5％，严重窦性心动：立缓发生率分别为0、3％、15％和25％，低血压发生率分别为5％、7％、8％和8％。与C组比较，D1组、D2组、D3组呛咳反应发生率降低，D2组、D，组严重窦性心动过缓发生率升高（P〈0．01）；D。组、D2组、D，组间呛咳反应发生率比较差异无统计学意义（P〉0．05）；4组呛咳反应程度和低血压发生率比较差异无统计学意义（P〉0．05）。结论静脉注射右美托咪啶0．10μg／kg可安全、有效地预防全麻诱导期间舒芬太尼诱发的呛咳反应。

Objective To investigate the feasibility of different doses of dexmedetomidine required to prevent sufentanil-induced cough during anesthesia induction. Methods Two hundred and forty ASA I or Ⅱ patients, aged 18-55 yr, weighing 45-78 kg, undergoing elective gynecological operations under general anaesthesia, were randomly divided into 4 groups （n = 60 inch） ： Ⅰ -Ⅳ groups. Ⅱ-Ⅳ groups received iv infusion of dexmedetomidine 0.10, 0.25 and 0.50 μg/kg at a rete of 0.05 μg·kg^- 1 . min^-1 respectively before anesthesia induction. Anesthesia was induced with target-controlled infusion of propofol （target effect-site concentration 5 μg/ml）, when the BIS value reached 55, iv sufentanil 0.5μg was injected over 3 s. The occurrence and degree of cough were recorded within 1 rain after sufentanil injection. Tracheal intubation was facilitated with suceinylcholine 1-2 mg/kg after the observation. The adverse cardiovascular events （severe sinus bradycardia, hypotension） were also record- ed from the start of dexmedetomidine infusion to 1 min after intubation. Results The incidences of cough were 25% , 7% , 7% and 5% , incidences of severe sinus bradycardia 0, 3% , 15% and 25% , and incidences of hypotension5%, 7%, 8% and 8% in Ⅰ- Ⅳ groups respectively. Compared with group I , the incidences of cough were significantly decreased in Ⅱ - Ⅳ groups, while the incidences of severe sinus bradycardia increased in Ⅲ-Ⅳgroups （P 〈 0.01）. There was no signficant difference in the incidences of cough among Ⅱ- Ⅲ groups and in the degree of cough among the four grvups （ P 〉 0.05 ）. Conclusion Intravenous dexmedetomidine 0.10 μg/kg can be used to prevent sufentanil-induced cough during anesthesia induction