右美托咪定经鼻与静脉给药预防舒芬太尼呛咳反应的效果比较

Comparison of the effects of intranasal and intravenous administration of dexmedetomidine on the prevention of cough response to sufentanil

目的比较右美托咪定经鼻与静脉给药预防舒芬太尼呛咳反应的效果。方法选择2020年1月至2022年1月采用舒芬太尼行全身麻醉的238例患者为研究对象,以随机数字表法将其分为A组和B组,每组119例。用相同药物行麻醉诱导、麻醉维持,A组麻醉诱导前给予右美托咪定滴鼻给药,B组麻醉诱导前15 min至手术结束期间给予右美托咪定持续静脉泵注给药。比较两组的应用效果。结果B组的呛咳发生率为3.36%,低于A组的10.92%(P<0.05);两组的呛咳严重程度比较,差异无统计学意义(P>0.05)。麻醉时(T_(0))、气管插管后3 min(T_(3)),两组的心率、平均动脉压比较,差异无统计学意义(P>0.05);麻醉后3 min(T_(1))、气管插管后1 min(T_(2)),B组的心率、平均动脉压高于A组(P<0.05);T_(1),两组的心率、平均动脉压低于T_(0)、T_(2)、T_(3)(P<0.05);T_(2),两组的心率、平均动脉压低于T_(0)、T_(3)(P<0.05)。B组的不良事件总发生率为21.85%,高于A组的9.24%(P<0.05)。结论右美托咪定能够预防舒芬太尼全身麻醉诱导所致呛咳,且相较于经鼻给药,持续静脉给药可充分发挥药物生物利用度,预防呛咳的效果更优,但存在心动过缓风险。

Objective To compare the effects of intranasal and intravenous administration of dexmedetomidine on the prevention of cough response to sufentanil.Methods A total of 238 patients undergoing general anesthesia with sufentanil from January 2020 to January 2022 were selected as the research objects.The patients were divided into group A and group B by random number table method,with 119 cases in each group.Anesthesia induction and maintenance were performed with the same drugs.The group A was given intranasal administration of dexmedetomidine before anesthesia induction,and the group B was given continuous intravenous infusion of dexmedetomidine from 15 min before anesthesia induction to the end of surgery.The application effects of the two groups were compared.Results The incidence of cough in the group B was 3.36%,which was lower than 10.92%in the group A(P<0.05);there was no significant difference in the severity of cough between the two groups(P>0.05).There were no significant differences in heart rate and mean arterial pressure between the two groups during anesthesia(T_(0))and 3 min after tracheal intubation(T_(3))(P>0.05);at 3 min after anesthesia(T_(1))and 1 min after tracheal intubation(T_(2)),the heart rate and mean arterial pressure in the group B were higher than those in the group A(P<0.05);at T_(1),the heart rate and mean arterial pressure of the two groups were lower than those at T_(0),T_(2)and T_(3)(P<0.05);at T_(2),the heart rate and mean arterial pressure of the two groups were lower than those at T_(0)and T_(3)(P<0.05).The total incidence of adverse events in the group B was 21.85%,which was higher than 9.24%in the group A(P<0.05).Conclusion Dexmedetomidine can prevent cough induced by sufentanil general anesthesia induction,compared with intranasal administration,continuous intravenous administration can give full play to the bioavailability of the drug,the effect of preventing cough is better,but there is a risk of bradycardia.