艾司氯胺酮雾化吸入抑制芬太尼诱发呛咳反应的研究

The Inhibition of Fentanyl-induced Cough Response by Aerosol Inhalation of Esmketamine

目的 探讨艾司氯胺酮雾化吸入抑制芬太尼诱发呛咳反应的临床价值。方法 选择2020年9月—2021年2月医院收治的胆囊结石行腹腔镜下胆囊切除术者97例为研究对象,按照随机数字表法分为观察组(48例)和对照组(49例),对照组行常规静脉快诱导气管插管,观察组先行艾司氯胺酮氧气雾化吸入,随后实施静脉快诱导气管插管术,比较两组麻醉诱导时呛咳持续时间及呛咳评分,比较麻醉诱导完成时机体应激激素水平变化、麻醉诱导过程中发生的不良反应,分析两组麻醉插管前后气道平台压变化情况。结果 观察组麻醉诱导时呛咳持续时间短于对照组,差异有统计学意义(P <0.05),呛咳评分低于对照组,差异有统计学意义(P <0.05),麻醉诱导完成时观察组肾上腺素和去甲肾上腺素水平均显著低于对照组,差异有统计学意义(P <0.05),观察组屏气、胃内容物返流、低氧血症及高血压的发生率显著低于对照组,差异有统计学意义(P <0.05),观察组人工手控呼吸时及插管完成机控呼吸时气道平台压均显著低于对照组,差异有统计学意义(P <0.05)。结论 全身麻醉气管插管前雾化吸入艾司氯胺酮,能有效地减少呛咳发生率,即便出现呛咳亦可有效降低其严重程度,降低机体应激反应,减少麻醉诱导并发症,改善呼吸功能。

Objective To explore the clinical value of aerosol inhalation of estazolam in inhibiting cough response induced by fentanyl.Methods From September 2020 to February 2021,a total of 97 patients with cholecystolithiasis who underwent laparoscopic cholecystectomy in our hospital were selected as the research objects.They were randomly divided into observation group(48 cases) and control group(49 cases).The control group was given routine intravenous rapid induction endotracheal intubation,and the observation group received esketamine oxygen atomization inhalation first,and then underwent intravenous fast-induction tracheal intubation.The duration and cough score of anesthesia induction were compared between the two groups.The changes in the levels of stress hormones at the end of anesthesia induction and the adverse reactions during anesthesia induction were compared,and the changes in airway platform pressure before and after anesthesia intubation in the two groups were analyzed.Results The duration of cough in the observation group was shorter than that in the control group,the difference was statistically significant(P <0.05),and the cough score was lower than that in the control group,the difference was statistically significant(P <0.05).The levels of adrenaline and norepinephrine in the observation group were significantly lower than those in the control group,the difference was statistically significant(P <0.05),and the total proportion of breath holding,gastric reflux,hypoxemia and hypertension in the observation group was significantly lower than that in the control group,the difference was statistically significant(P <0.05).The airway platform pressure of the observation group during manual breathing and when the machine-controlled breathing was completed by intubation were significantly lower than those in the control group,and the difference was statistically significant(P <0.05).Conclusion Inhalation of esketamine before trache al intubation under general anesthesia can effectively reduce the incidence of cough,and even if cough occurs,it can effectively reduce its severity,reduce the stress response of the body,reduce the complications induced by anesthe sia and improve the re spiratory function.