CAJ | 학술논문

目的评价麻醉诱导时芬太尼不同给药方法对其诱发患者咳嗽的影响.方法择期全麻手术患者420例,年龄18～60岁,性别不限,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将患者随机分为4组(n=105):常规组(Ⅰ组)、预注射组(Ⅱ组)、稀释组(Ⅲ组)和后注射组(Ⅳ组).麻醉诱导:Ⅰ组依次静脉注射咪达唑仑0.05 mg/kg、芬太尼(50 μg/ml)2 μg/kg、异丙酚2 mg/kg、罗库溴铵1mg/kg;Ⅱ组依次静脉注射咪达唑仑0.05 mg/kg、芬太尼(50 μg/ml)0.5 μg/kg、异丙酚2 mg/kg、罗库溴铵1mg/kg、芬太尼(50 μg/ml)1.5 μg/kg;Ⅲ组依次静脉注射咪达唑仑0.05 mg/kg、芬太尼(20 μg/ml)2μg/kg、异丙酚2mg/kg、罗库溴铵1 mg/kg;Ⅳ组依次静脉注射咪达唑仑0.05 mg/kg、异丙酚2 mg/kg、罗库溴铵1 mg/kg、芬太尼(50 μg/ml)2 μg/kg.注药完毕后2 min行气管插管.气管插管前观察咳嗽、异丙酚注射痛的发生情况,于麻醉诱导前、诱导后、咳嗽时、气管插管时记录HR和有创动脉压.结果与Ⅰ组比较,其余组患者咳嗽发生率和咳嗽程度降低(P＜0.05)；与Ⅱ组和Ⅲ组比较,Ⅳ组患者咳嗽发生率和咳嗽程度降低(P＜0.05).四组其余指标组间比较差异无统计学意义(P＞0.05).结论麻醉诱导时芬太尼稀释给药、给予预注剂量或后注射均可明显降低其诱发咳嗽的发生,其中后注射效果最佳.
목적 평개마취유도시분태니불동급약방법대기유발환자해수적영향.방법 택기전마수술환자420례,년령18～60세,성별불한,ASA분급Ⅰ혹Ⅱ급,채용수궤수자표법,장환자수궤분위4조(n=105):상규조(Ⅰ조)、예주사조(Ⅱ조)、희석조(Ⅲ조)화후주사조(Ⅳ조).마취유도:Ⅰ조의차정맥주사미체서륜0.05 mg/kg、분태니(50 μg/ml)2 μg/kg、이병분2 mg/kg、라고추안1mg/kg;Ⅱ조의차정맥주사미체서륜0.05 mg/kg、분태니(50 μg/ml)0.5 μg/kg、이병분2 mg/kg、라고추안1mg/kg、분태니(50 μg/ml)1.5 μg/kg;Ⅲ조의차정맥주사미체서륜0.05 mg/kg、분태니(20 μg/ml)2μg/kg、이병분2mg/kg、라고추안1 mg/kg;Ⅳ조의차정맥주사미체서륜0.05 mg/kg、이병분2 mg/kg、라고추안1 mg/kg、분태니(50 μg/ml)2 μg/kg.주약완필후2 min행기관삽관.기관삽관전관찰해수、이병분주사통적발 생정황,우마취유도전、유도후、해수시、기관삽관시기록HR화유창동맥압.결과 여Ⅰ조비교,기여조환자해수발생솔화해수정도강저(P＜0.05)；여Ⅱ조화Ⅲ조비교,Ⅳ조환자해수발생솔화해수정도강저(P＜0.05).사조기여지표조간비교차이무통계학의의(P＞0.05).결론 마취유도시분태니희석급약、급여예주제량혹후주사균가명현강저기유발해수적발생,기중후주사효과최가.
Objective To compare the effects of different medications of fentanyl during anesthesia induction on fentanyl-induced cough.Methods Four hundred and twenty ASA Ⅰ or Ⅱ patients aged 18-60 yr undergoing selective operations under general anesthesia,were randomly divided into 4 groups ( n =105 each):group Ⅰ (control group) received successive intravenous injection of midazolam 0.05 mg/kg,fentanyl 2 μg/kg,propofol 2 mg/kg,and rocuronium 1 mg/kg,group Ⅱ (pre-injection group) received successive intravenous injection of midazolam0.05 mg/kg,fentanyl 0.5 μg/kg,propofol 2 mg/kg,rocuronium 1 mg/kg,and fentanyl 1.5 μg/kg,group Ⅲ (dilution group) received successive intravenous injection of midazolam 0.05 mg/kg,fentanyl 2 μg/kg (20 μg/ml),propofol 2 mg/kg,and rocuronium 1 mg/kg,and group Ⅳ (last injection group) received successive intravenous injection of midazolam 0.05 mg/kg,propofol 2 mg/kg,rocuronium 1 mg/kg,and fentanyl 2 μg/kg.Fentanyl concentration was 50 μg/ml in each group except group Ⅲ.Endotracheal intubation was performed 2 min after anesthesia induction.The incidence and severity of fentanyl-induced cough before intubation were recorded and the incidence of propofol-induced pain was recorded.Invasive arterial blood pressure (ABP) and heart rate (HR) were observed before induction (T1 ),immediately after induction (T2 ),at time of coughing (T3 ),and at time of endotracheal intubation (T4).Results ABP and HR had no significant differences at T1,T2,T3,and T4between the four groups (P ＞ 0.05).The incidence of propofol-induced pain had no significant differences between the four groups (P ＞ 0.05).The incidences of cough was 7.6％ in group Ⅱ,9.5％ in group Ⅲ,and 1.9％ in group Ⅳ,which were significantly lower than 35.2％ in group Ⅰ ( P ＜ 0.01).The incidence of cough in group Ⅳ was significantly lower than that in groups [ and Ⅲ (P ＜ 0.05).In the four groups,ABP and HR were significantly higher at T3 than that at T1 and T2 ( P ＜ 0.01 ).Conclusion Different medications of fentanyl including last injection,pre-injection,and dilution of fentanyl can significantly reduce the incidence of fentanyl-induced cough during anesthesia induction,and injection has the best effect.