右美托咪定与地塞米松抑制妇科肿瘤患者全身麻醉诱导时舒芬太尼诱发呛咳的效果比较

Effect comparison of dexmedetomidine and dexamethasone on suppressing sufentanil-induced cough during general anesthesia induction in patients with gynecological tumors

目的探讨右美托咪定和地塞米松抑制妇科肿瘤患者全身麻醉诱导时阿片类药物诱发呛咳(OIC)的有效性、安全性。方法选取山西省肿瘤医院2019年3月至11月180例拟择期行全身麻醉下妇科肿瘤手术患者,按照随机数字表法分为空白对照组、右美托咪定组、地塞米松组,各60例。患者入室首先静息10 min(T0)。全身麻醉诱导前处理:右美托咪定组经电子输注泵泵入右美托咪定0.5μg/kg(以0.9%NaCl注射液稀释至10 ml),地塞米松组静脉注射地塞米松10 mg,空白对照组泵入10 ml 0.9%NaCl注射液。5 min内泵完,泵注结束时间记为T1。泵注结束5 min后开始行麻醉诱导:首先静脉注射舒芬太尼0.3μg/kg,5 s内注射完结(T2)。舒芬太尼注射2 min后(T3)依序注射苯磺顺阿曲库铵0.3 mg/kg,丙泊酚中长链注射液2 mg/kg,诱导后行去氮给氧、气管插管机械通气,插管后1 min记为T4。记录各组T2~T3期间OIC的发生率及严重性,以及T1~T4期间心动过速、心动过缓、高血压、低血压、呼吸抑制和肌强直的发生率。结果右美托咪定组(10.0%,6/60)、地塞米松组(8.3%,5/60)患者OIC发生率均低于空白对照组(33.3%,20/60),三组差异有统计学意义(χ^(2)=16.445,P<0.01),右美托咪定组与地塞米松组间OIC发生率差异无统计学意义(P>0.05)。右美托咪定组窦性心动过缓发生率(16.3%,10/60)高于空白对照组(0,0/60)与地塞米松组(8.4%,1/60),差异有统计学意义(P<0.05)。三组患者均未出现呼吸抑制、肌强直。结论麻醉诱导前应用右美托咪定或静脉注射地塞米松预处理均可有效降低妇科肿瘤患者OIC发生率,两者作用效果无明显差异。输注右美托咪定后窦性心动过缓发生率升高。

Objective To investigate the efficacy and safety of dexmedetomidine and dexamethasone in inhibiting opioid-induced cough(OIC)during general anesthesia induction in patients with gynecological tumors.Methods A total of 180 patients who were scheduled for elective gynecological tumor surgery under general anesthesia in Shanxi Provincial Cancer Hospital from March to November 2019 were selected.They were randomly divided into blank control group,dexmedetomidine group and dexamethasone group according to the random number table method,each group had 60 cases.Firstly,all patients had a 10-minute rest(T0)after they entered the operate room.Treatment before general anesthesia induction:dexmedetomidine group was pumped dexmedetomidine 0.5μg/kg(diluted to 10 ml with 0.9%NaCl injection)using an electronic infusion pump;dexamethasone group was injected intravenously dexamethasone 10 mg;blank control group was pumped with 10 ml 0.9%NaCl injection.The pumping was finished within 5 minutes,and the end time of pumping was denoted as T1.Induction of general anesthesia was performed 5 minutes after the end of pumping:firstly,sufentanil was given intravenously at 0.3μg/kg,and the injection was finished within 5 seconds(T2).Two minutes after sufentanil injection(T3),cis-atracurium 0.3 mg/kg and propofol medium/long-chain injection 2 mg/kg were sequentially injected.Then preoxygenation,endotracheal intubation and mechanical ventilation were implemented in turn.One minute after intubation was recorded as T4.The incidence and severity of cough in patients within T2-T3 of each group were recorded,as well as the incidence of tachycardia,bradycardia,hypertension,hypotension,respiratory depression and myotonia during T1-T4.Results The incidence of OIC in the dexmedetomidine group(10.0%,6/60)and dexamethasone group(8.3%,5/60)was lower than that in the blank control group(33.3%,20/60),and the difference among the three groups was statistically significant(χ^(2)=16.445,P<0.01),while there was no significant difference in the incidence of OIC between the dexmedetomidine group and the dexamethasone group(P>0.05).The incidence of sinus bradycardia in the dexmedetomidine group(16.3%,10/60)was higher than that in the blank control group(0,0/60)and dexamethasone group(8.4%,1/60),and the difference was statistically significant(P<0.05).Respiratory depression and myotonia did not occur in the three groups.Conclusions Pretreatment with dexmedetomidine or intravenous dexamethasone before anesthesia induction can effectively reduce the incidence of OIC in patients with gynecological tumors,and there is no significant difference between the effects of the two drugs.The incidence of sinus bradycardia increases significantly after dexmedetomidine infusion.