不同剂量的右美托咪定对芬太尼诱发呛咳反应的影响

Effect of dexmedetomidine on fentanyl-induced cough during anesthesia induction

目的观察右旋美托咪定对芬太尼诱发呛咳反应的影响。方法择期全麻手术患者120例随机均分为四组,麻醉诱导前分别泵注右美托咪定0.2μg/kg(D1组)、0.4μg/kg(D2组)、0.6μg/kg(D3组)或生理盐水(C组),泵注时间均为10min。泵注结束后所有患者均在2s内快速静脉输注芬太尼4μg/kg,2min后静脉给予丙泊酚1.5mg/kg和维库溴胺0.1mg/kg行麻醉诱导、气管插管。记录芬太尼注射后1min内呛咳反应发生的情况和程度,记录开始静注右美托咪定至气管插管后3min的血流动力学变化和不良心血管反应事件。结果 D1组、D2组、D3组和C组呛咳的发生率分别为23.3%、26.7%、20.0%和60.0%;D1组、D2组和D3组呛咳的发生率均显著低于C组(P<0.01)。D2和D3组严重窦性心动过缓发生率明显高于D1组和C组(20.0%、23.3%vs.6.7%、3.3%)(P<0.05)。结论麻醉诱导前静脉输注右美托咪定0.2μg/kg能安全有效抑制芬太尼诱发的呛咳反应。

Objective To investigate the effect of dexmedetomidine on fentanyl-induced cough during anesthesia induction. Methods A total of 120 patients undergoing selective surgery was equally randomized into four groups, who were injected dexmedetomidine 0. 2μg/kg（group D1 ）, 0.4 μg/kg （group D2）,0. 6μg/kg（group D3） or normal saline（group C） within 10 min. Anesthesia induction with intravenous injection of fentanyl 4μg/kg in 2 s and propofol 1.5 rng/kg was performed after the injection. The episodes of cough within 1 min after fentayl injection were recorded. HR and BP were monitored during anesthesia induction. Results The incidences of fentanyl-induced cough in groups of D1,D2 D,5 and C were 23.3%, 26.7%, 20% and 60%, respectwely. lhe incidence ot cough was higher in groups of D1,D2 and D3 than that in group C（P〈0. 01）. The incidence of sinus bradycardia was higher in groups of D2 and D3 than that in groups of D1 and C（20% and 23.3% vs. 6.7% and 3.3%） （P（0. 05）. Condusion Dexmedetomidine 0.2 μg/kg infused in 10 min before anesthesia induction with intravenous injection of fentanyl can effectively and safely suppressed the fentanyl- induced cough.