联合麻醉诱导时芬太尼诱发咳嗽相关因素的研究

Stepwise discriminant analysis on the related factors of fentanyl-induced coughing

目的探讨联合麻醉诱导时影响芬太尼诱发咳嗽的可能因素。方法全麻患者304例,ASAⅠ或Ⅱ级。观察静注芬太尼后1 min内患者有无咳嗽。进行性别(X1)、年龄(X2)、体重指数(BMI,X3)、咪达唑仑用量(X4)、芬太尼首量(X5)、芬太尼注射时间(X6)、给药途径(X7)、稀释与否(X8)及嗜酸性粒细胞(X9)等指标的逐步判别分析,用筛选出的因素进一步做Bayes判别分析。结果当剔、选水平取0.3时,筛选出判别能力由大到小依次为年龄、芬太尼首量、芬太尼注射时间、性别和BMI 5个有显著性因素,求得Fisher准则下的判别函数表达式Z=0.371X1-0.025X2+0.022X3+0.379X5-0.043X6,判别临界值为Zc=-0.532,方程χ2=33.380,P=0.000。由原始样本建立判别方程的判对率及交叉验证判对率分别为68.1%和64.9%。结论年龄、芬太尼首量、芬太尼注射时间、性别和BMI是芬太尼麻醉诱导时诱发咳嗽的主要因素,增龄、延长芬太尼注射时间及女性为保护因素,能减少咪达唑仑-芬太尼诱导时咳嗽的发生。

Objective To study the factors that influence the explosive coughing induced by bolus fentanyl injection during general anesthesia induction. Methods Three hundreds and four patients, ASA grade Ⅰ or Ⅱ, accept general anesthesia induction. Coughs were observed immediately in 1 rain after fentanyl administration. The correlation between the dependent variable （Y） and nine parameters （X1） including patient＇s gender（Xl ）, age （X2） and body mass index （BMI, X3 ）, dosage of midazolam （X4）, dosage the first dose（X5 ） and injection time（X6 ）of fentanyl, the approach of drug administration（X7 ）, dulation （X8） of fentanyI, eosinophil （X9） in blood routine test were analysed by step by-step discrimiant analysis followed by Bayes test with new factors selected. Results X1, X2, X3, X5 and X6 were selected when 0. 3 was used as the distinct level and the discriminant function under Fisher rule was Z=0. 371X1 -0. 025X2 ＋0. 022X3 ＋0. 379X5 -0. 043X6, Zc=--0. 532, X2 = 33. 380, P=0. 000. The predictive accuracy of classification function by original grouped and cross validation were 68. 1% and 64.9% respectively. Conelusion Age, BMI, dosage of the first dose, the injection time of fentanyl and gender are the possible factors that influence the fentanyl induced coughing. The elder, female and prolonged time of fentanyl injection are the main Drotective factors.