预注射地佐辛预防心血管手术全麻诱导期舒芬太尼诱发的咳嗽反射:一项前瞻、双盲、随机对照研究

Pretreatment of Dezocine Prevents Sufentanil-induced Cough during General Anesthesia Induction in Cardiovascular Surgery:A Prospective,Double-blind,Randomized Controlled Trial

目的观察预注射地佐辛对心血管手术全麻诱导期舒芬太尼诱发咳嗽反射的预防作用。方法选择阜外医院择期行全麻气管插管的心血管手术患者40例,随机分为地佐辛组和对照组(n=20)。麻醉诱导前,地佐辛组静脉注射0.1 mg/kg地佐辛,对照组静脉注射等体积生理盐水,两组患者均在预注射1 min后的3 s内静脉注射2μg/kg舒芬太尼,观察并记录静脉注射舒芬太尼1 min内咳嗽发生率、咳嗽严重程度和全麻诱导期头晕、恶心呕吐等并发症及有创动脉血压、心率、脑电双频谱指数等指标。结果地佐辛组无患者发生咳嗽,对照组8例(40%)患者发生咳嗽(轻度:5%,中度:0,重度:35%);地佐辛组咳嗽发生率及咳嗽严重程度显著低于对照组(P=0.002)。对照组静脉注射舒芬太尼1 min后的收缩压高于地佐辛组[(141.63±24.15)mmHg vs(127.05±20.72)mmHg,P=0.049];对照插管前的脑电双频谱指数低于地佐辛组(36.20±6.44 vs 44.10±10.98,P=0.008)。结论全麻诱导前静脉注射0.1 mg/kg地佐辛能有效抑制舒芬太尼引起的咳嗽,且不明显增加并发症的发生。

Objective To explore the preventive effect of dezocine pretreatment on sufentanil-induced cough during induction of general anesthesia in cardiovascular surgery.Methods A total of 40 patients scheduled for elective cardiovascular surgery were randomly divided into dezocine group and control group(n=20).Patients received dezocine 0.1 mg/kg in dezocine group and an equal volume of 0.9%normal saline in control group one min prior to intravenous sufentanil 2μg/kg.The incidence and severity of cough in patients were evaluated within one min after the injection of sufentanil.The complications such as dizziness,nausea and the values of invasive arterial blood pressure,heart rate,bispectral(BIS)index during anesthesia induction were recorded.Results No patient in dezocine group had cough and 8(40%)patients in control group had cough(severity of cough:mild,5%;moderate,0;severe,35%).The incidence and severity of cough in dezocine group was significantly lower than that in control group(P=0.002).The systolic blood pressure(SBP)was significantly higher in control group than that in dezocine group([141.63±24.15]mmHg vs[127.05±20.72]mmHg,P=0.049)one min after sufentanil administration.The BIS index was lower in control group than that in dezocine group(36.20±6.44 vs 44.10±10.98,P=0.008)before tracheal intubation.Conclusion Intravenous pretreatment of dezocine 0.1 mg/kg prior to induction is effective and safe in suppressing sufentanil-induced cough.