麻黄碱联合丙泊酚抑制芬太尼咳嗽反射的临床研究

Effects of ephedrine and propofol on fentanyl-induced cough during induction of general anesthesia

目的:研究麻黄碱联合丙泊酚对芬太尼咳嗽反射(fentanyl-induced cough,FIC)的抑制作用。方法:选择320例择期手术接受全麻的患者,根据计算机随机数字表随机进入4组:Ⅰ组(对照组)静脉注射2mL生理盐水;Ⅱ组(麻黄碱组)静脉注射6mg麻黄碱;Ⅲ组(丙泊酚组)静脉注射0.8mg/kg丙泊酚;Ⅳ组(丙泊酚联合麻黄碱组)静脉注射0.8mg/kg丙泊酚加6mg麻黄碱。给予治疗药物2min后,经外周静脉快速注射2μg/kg芬太尼。观察并记录患者的血压、心率、脉博血氧饱和度等生命体征,并由一位医师按照盲法观察注射芬太尼后1min内是否出现咳嗽,记录咳嗽发生的次数,并且根据咳嗽发生次数进行严重程度分级。结果:Ⅱ组、Ⅲ组和Ⅳ组患者的FIC发生率和严重程度均较Ⅰ组明显降低,而且Ⅳ组患者的血流动力学更加平稳。结论:麻醉诱导时联合应用麻黄碱和丙泊酚对FIC的抑制效果更好,患者血流动力学更加稳定,是临床上一个简单、有效的防治FIC的办法。

AIM： To evaluate the effective-ness of ephdrine, propofol and ephedrine com-bined with propofol on fentanyl-induced cough during anesthesia induction. METHODS： 320 patients with ASA Ⅰ or Ⅱ for elective proce-dures were randomly assigned into four groups and the following medications were administered intravenously, patients in Group Ⅰ （ control group） received normal saline 2 mL, Group Ⅱ （ephedrine group） received ephedrine 6 mg, Group Ⅲ （propofol group） received propofol 0.8 mg/kg and Group IV （ephedrine plus propo-fol group） received ephedrine 6 mg plus propofol 0.8 mg/kg . At one minute after the study med-ication, fentanyl 2.0 μg/kg was given intrave-nously within two seconds. The occurrence of cough and vital sign profiles were recorded with-in one minutes after fentanyl bolus. RESULTS. The incidence of FIC was 42.5% in group Ⅰ, 18.8% in group Ⅱ, 20.0% in group Ⅲ, and 2.5% in group Ⅳ, respectively. Lower inci-dence and less severity of cough were observed in groups Ⅱ, Ⅲ, and Ⅳ than those in group Ⅰ（P〈0.05）. Groups IV had a lower incidence and less severity of cough than those in group Ⅱ and group Ⅲ （P 〈0.05）. Hemodynamics was more stable in group Ⅳ than that in other groups. CONCLUSION. Intravenous ephedrine 6 mg plus propofol 0.8 mg/kg could prevent fent-anyl-induced cough effectively. It is a convenient method to suppress fentanyl-induced cough with stable hemodynamics in this setting.