不同药物配伍对麻醉诱导期注射痛及呛咳反应的影响

Effects of Different Compatibilities of Drugs on Propofol-induced Injection Pain and Fentanyl-induced Coughing during Anesthesia Induction

目的:探讨在全麻诱导期应用不同药物配伍对异丙酚注射痛和芬太尼诱导的呛咳反应的影响。方法:将180例ASAⅠ或Ⅱ级择期全麻手术患者随机分为6组(n=30)。D组患者在麻醉诱导前均泵注0.2μg·kg-1右美托咪定10 min,泵注结束后,D1组:2 s内静脉推注芬太尼4μg·kg-1,2 min后予异丙酚2.0 mg·kg-1;D2组:2 s内静脉推注芬太尼2μg·kg-1,2 min后予异丙酚2.0 mg·kg-1,患者睫毛反射消失后再给予芬太尼2μg·kg-1;D3组:给予异丙酚2.0 mg·kg-1,患者睫毛反射消失后再2 s内快速静脉推注芬太尼4μg·kg-1。M组患者均静脉给予咪唑安定0.06 mg·kg-1,1 min后M1组:2 s内快速静脉推注芬太尼4μg·kg-1,2 min后予异丙酚2.0 mg·kg-1;M2组:2s内快速静脉推注芬太尼2μg·kg-1,2 min后予异丙酚2.0 mg·kg-1,患者睫毛反射消失后再给予芬太尼2μg·kg-1;M3组:给予异丙酚2.0 mg·kg-1,患者睫毛反射消失后再2 s内快速静脉推注芬太尼4μg·kg-1。6组患者丙泊酚给药速度均为4 mg.s-1,均予维库溴胺0.1 mg·kg-1行快速静脉诱导、气管插管。记录第1次芬太尼注射后1 min内患者的呛咳反应发生情况和程度以及丙泊酚注射过程中的疼痛发生情况,记录开始静注右美托咪定至气管插管后3分钟的血流动力学变化和不良心血管反应事件。结果:D1～D3组以及M1～M3组患者呛咳的发生率分别为23.3%、20%、20%、60%、50%和43.3%,呛咳程度(中重度呛咳总发生率)分别为13.3%、10%、10%、46.7%、36.7%、和30%。D组各组的呛咳发生率和程度明显低于M组各组(P<0.01),D组各组间、M组各组间患者呛咳的发生率和呛咳程度比较差异无统计学意义(P>0.05)。D1～D3组以及M1～M3组异丙酚注射痛的发生率分别为6.7%、36.7%、60%、6.7%、33.3%和60%;D1组和M1组异丙酚注射痛的发生率显著低于其它各组(P<0.01)。结论:0.2μg·kg-1的右美托咪定和4μg·kg-1的芬太尼的使用能有效减少全麻诱导时产生的芬太尼呛咳反应和异丙酚注射痛。

Objective： To observe the effects of different compatibilities of drugs on fentanyl-induced coughing and propofol-induced injection pain during anesthesia induction. Methods： A total of 180 patients were randomly allocated into six groups （n=30, each）. Anesthesia induction for group D1~D3 was： first, all patients were injected with dexmedetomidine 0.2 μg·kg^-1 within 10 min, and then fentanyl （4 μg·kg^-1 in 2 s） and propofol in group D1, fentanyl （2 μg·kg^-1 in 2 s）, propofol and fentanyl （2 μg·kg^-1） in group D2, propofol and fentanyl （4 μg·kg^-1） in group D3. Midazolam 0.06 mg·kg^-1 was applied to all patients in group M1~M3, with fentanyl and propofol in the same compatibilities as group D1~D3. The dosage and injected speed of propofol in all groups was 2 mg·kg^-1 and 4 mg·s-1. The episodes of cough within 1 min after fentanyl injection and propofol-induced pain were recorded. HR and BP were monitored during anesthesia induction. Results： The incidences of fentanyl-induced coughing in group D1, D2, D3, M1, M2 and M3 were 23.3%, 20%, 20%, 60%, 50% and 43.3%, respectively. The coughing degrees in group D1, D2, D1, M1, M2 and M3 were 13.3%, 10%, 10%, 46.7%, 36.7% and 30%, respectively. So, the incidences and the coughing degrees in group Ds were lower than those in group Ms （P〈0.01）, while there was no significant difference within group Ds or Ms （P〉0.05）. The incidences of propofol-induced pain in group D1 and M1 （6.7% and 6.7%, respectively） were significantly lower than those in D2, D3, M2 and M3 （36.7%, 60%, 33.3% and 60%, respectively）（P〈0.01）. Conclusion： The use of 0.2 μg·kg^-1 dexmedetomidine and 4 μg·kg^-1 fentanyl could effectively suppress fentanyl-induced coughing and propofol injection pain during anesthesia induction.