预注利多卡因对芬太尼诱发咳嗽的影响

The effects of pretreatment with lidocaine on fentanyl-induced cough

目的观察不同剂量利多卡因对芬太尼诱发咳嗽的抑制作用,探讨预防咳嗽的安全有效剂量。方法 200例需全身麻醉择期手术患者按随机数字法分为4组,每组50例。组Ⅰ为利多卡因0.5 mg/kg,组Ⅱ为利多卡因1.0 mg/kg,组Ⅲ为利多卡因1.5 mg/kg,组Ⅳ为生理盐水10 mL的对照组,各利多卡因组均以生理盐水稀释至10 mL。观察4组患者注射利多卡因和生理盐水后头晕、耳鸣中毒症状发生率;观察4组患者注射芬太尼后咳嗽的发生率和严重程度。结果组Ⅲ、组Ⅱ头晕、耳鸣的发生率明显高于对照组(P<0.05),组Ⅲ头晕、耳鸣的发生率明显高于组Ⅱ;组Ⅲ、组Ⅱ咳嗽的发生率明显低于对照组(P<0.05),组Ⅲ与组Ⅱ比较差异无统计学意义(P>0.05);组Ⅰ、组Ⅱ、组Ⅲ咳嗽严重程度比较无统计学差异(P>0.05)。结论静脉注射利多卡因1.0 mg/kg能有效抑制芬太尼诱发咳嗽反射,毒性反应轻,临床使用安全。

Objective To observe the inhibitory effects of different doses of lidocaine on fentanyl-induced cough and to ex- plore the safe and effective dosage to prevent cough. Methods All 200 cases of patients in need of general anesthesia for elective surgery were randomLy divided into four groups,with 50 patients in each group.with lidocaine 0.5 mg/kg in group Ⅰ,lidocaine 1.0 mg/kg in group Ⅱ,lidocaine 1.5 mg/kg in group m respectively,and with 10 mL of normal saline in group Ⅳ （the control group）. The lidocaine groups are diluted with normal saline to 10 mL. Then to observe the incidence of dizziness and tinnitus poisoning in four groups of patients after injection of lidocaine and saline, and also observe the inci- dence and severity of cough in those patients after injection of fentanyl. Results The incidence of dizziness and tinnitus in group I1 and group m was significantly higher than in group 1V（P 〈 0.05） while the cough incidence of group I1 and group ]U was significantly lower than the control group （P 〈 0.05）. The difference between groupⅢ and group Ⅱ was not statistically significant（P 〉 0.05） ,and there was no significant difference in cough severity among group Ⅰ , group Ⅱ and group m （P 〉 005） Conclusion Intravenous injection of lidocaine 1.0 mg/kg can effectively inhibit the fentanyl-induced cough reflex and can reduce toxic reaction. It is a clinically safe treatment.