右美托咪定对靶控输注瑞芬太尼所致咳嗽反射的影响

Effect of dexmedetomidine to reduce the incidence of remifentanil induced cough

目的探讨右美托咪定对靶控输注(TCI)瑞芬太尼所致咳嗽反射的影响。方法选取在全麻下行外科手术患者150例,随机均分为三组:对照组(Ⅰ组)、右美托咪定0.5μg/kg组(Ⅱ组)、右美托咪定1.0μg/kg组(Ⅲ组)。在TCI瑞芬太尼前,分别泵注生理盐水10ml(Ⅰ组)、右美托咪定0.5μg/kg(Ⅱ组)与右美托咪定1.0μg/kg(Ⅲ组)。观察TCI瑞芬太尼后咳嗽反射的发生率、严重程度、血流动力学变化及恶心、呕吐及呼吸抑制不良反应发生情况。结果Ⅱ、Ⅲ组咳嗽反射发生率明显低于Ⅰ组(P<0.05);Ⅲ组咳嗽反射发生率明显低于Ⅱ组(P<0.05);三组患者MAP和HR差异无统计学意义;三组患者均未发生恶心、呕吐及呼吸抑制不良反应。结论在TCI瑞芬太尼前泵注右美托咪定1.0μg/kg能有效地降低咳嗽反射的发生率,不增加呼吸抑制、恶心、呕吐等不良反应的发生。

Objective Efficacy of dexmedetomidine（DEX）to reduce the incidence and severity of remifentanil induced cough.Methods One hundred and fifty patients,undergoing elective surgical procedures were randomly allocated into three equal groups to receive either 10 ml normal saline（group Ⅰ）,DEX 0.5μg/kg in 10 ml of normal saline（groupⅡ）or DEX 1μg/kg in 10 ml of normal saline（groupⅢ）in 10 min.All groups then received administration of remifentanil at a target effectsite concentration of 8ng/ml.The incidence and severity of cough,hemodynamic variables,and the incidence of nausea,vomiting and respiratory depression were recorded.Results The incidence of remifentanil induced cough was significantly lower in groupⅡ and groupⅢ than that in groupⅠ（P〈0.05）,and was significantly lower in group Ⅲ than that in group Ⅱ（P〈0.05）.However,there was no significant difference in the hemodynamic variables,and the incidence of nausea,vomiting and respiratory depression between the groups.Conclusion Intravenous dexmedetomidine（1μg/kg）immediately before the administration of remifentanil at a target effect-site concentration of 8ng/ml significantly reduces the incidence of remifentanil induced cough,and does not increase the incidence of adverse effects such as nausea,vomiting and respiratory depression.