中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2010年
13期
921-923
,共3页
王磊%姚锦华%朱君健%刘斌%朱建国%周大春
王磊%姚錦華%硃君健%劉斌%硃建國%週大春
왕뢰%요금화%주군건%류빈%주건국%주대춘
麻醉%全身%药物投放%芬太尼%呛咳
痳醉%全身%藥物投放%芬太尼%嗆咳
마취%전신%약물투방%분태니%창해
General anesthesia%Drug administration%Fentanyl%Coughing
目的 探讨能否通过优化全麻诱导用药预防芬太尼呛咳反应.方法 将浙江省平湖市第一人民医院2009年1-8月120例美国麻醉医师协会(ASA)Ⅰ～Ⅱ级择期全麻下手术患者,采用数字随机法分成2组.优化组患者全麻诱导用药方法为:先静脉注射咪唑安定0.06 mg/kg、1 min时芬太尼1μg/kg(1 s内注入)、1 min 55 s时静脉注射维库溴铵0.1mg/kg、2min时静脉注射丙泊酚1.5～2 mg/kg、2 min 20s时将3μg/kg芬太尼在2s内注入、5 min时行气管插管.对照组患者全麻诱导用药方法为:先静脉注射咪唑安定0.06mg/kg、1 min时芬太尼4μg/kg(3 s内注入)、1 min 55 s时维库溴铵0.1 mg/kg、2 min时丙泊酚1.5～2 mg/kg、5 min时行气管插管.观察芬太尼呛咳的发生率和程度、诱导前后血流动力学的变化.结果 两组诱导期间血流动力学变化无显著差异提示都能成功抑制插管反应.优化组比对照组呛咳率明显降低(分别为4/60和23/60,P<0.01),呛咳强度明显减弱(重度呛咳率分别为0/60和8/60,P<0.05).结论 全麻诱导时分次注射芬太尼不影响对插管反应的抑制,可以明显降低呛咳发生率和强度,对预防麻醉诱导期并发症有积极意义.
目的 探討能否通過優化全痳誘導用藥預防芬太尼嗆咳反應.方法 將浙江省平湖市第一人民醫院2009年1-8月120例美國痳醉醫師協會(ASA)Ⅰ～Ⅱ級擇期全痳下手術患者,採用數字隨機法分成2組.優化組患者全痳誘導用藥方法為:先靜脈註射咪唑安定0.06 mg/kg、1 min時芬太尼1μg/kg(1 s內註入)、1 min 55 s時靜脈註射維庫溴銨0.1mg/kg、2min時靜脈註射丙泊酚1.5～2 mg/kg、2 min 20s時將3μg/kg芬太尼在2s內註入、5 min時行氣管插管.對照組患者全痳誘導用藥方法為:先靜脈註射咪唑安定0.06mg/kg、1 min時芬太尼4μg/kg(3 s內註入)、1 min 55 s時維庫溴銨0.1 mg/kg、2 min時丙泊酚1.5～2 mg/kg、5 min時行氣管插管.觀察芬太尼嗆咳的髮生率和程度、誘導前後血流動力學的變化.結果 兩組誘導期間血流動力學變化無顯著差異提示都能成功抑製插管反應.優化組比對照組嗆咳率明顯降低(分彆為4/60和23/60,P<0.01),嗆咳彊度明顯減弱(重度嗆咳率分彆為0/60和8/60,P<0.05).結論 全痳誘導時分次註射芬太尼不影響對插管反應的抑製,可以明顯降低嗆咳髮生率和彊度,對預防痳醉誘導期併髮癥有積極意義.
목적 탐토능부통과우화전마유도용약예방분태니창해반응.방법 장절강성평호시제일인민의원2009년1-8월120례미국마취의사협회(ASA)Ⅰ～Ⅱ급택기전마하수술환자,채용수자수궤법분성2조.우화조환자전마유도용약방법위:선정맥주사미서안정0.06 mg/kg、1 min시분태니1μg/kg(1 s내주입)、1 min 55 s시정맥주사유고추안0.1mg/kg、2min시정맥주사병박분1.5～2 mg/kg、2 min 20s시장3μg/kg분태니재2s내주입、5 min시행기관삽관.대조조환자전마유도용약방법위:선정맥주사미서안정0.06mg/kg、1 min시분태니4μg/kg(3 s내주입)、1 min 55 s시유고추안0.1 mg/kg、2 min시병박분1.5～2 mg/kg、5 min시행기관삽관.관찰분태니창해적발생솔화정도、유도전후혈류동역학적변화.결과 량조유도기간혈류동역학변화무현저차이제시도능성공억제삽관반응.우화조비대조조창해솔명현강저(분별위4/60화23/60,P<0.01),창해강도명현감약(중도창해솔분별위0/60화8/60,P<0.05).결론 전마유도시분차주사분태니불영향대삽관반응적억제,가이명현강저창해발생솔화강도,대예방마취유도기병발증유적겁의의.
Objective To observe the effect of optimizing anesthetic injecting sequence during induction on fentanyl-induced coughing. Methods One hundred and twenty ASA Ⅰ or Ⅱ elective patients undergoing general anesthesia were randomly allocated to optimized group or control group: the optimized group induced with midazolam 0.06 mg/kg, followed by fentanyl 1 mg/kg at 1 min later, vecuronium 0. 1 mg/kg at 1 min55s, propofol 1.5-2 mg/kg at 2 min, a second dose of 3 mg/kg fentanyl at 2 min 20 s, intubated at time 5 min; the control group was induced with the same medication but all the fentanyl (4 mg/kg) was injected at time 1 min. Coughing after fentanyl injection was observed and hemodynamic parameters were recorded. Results Hemodynamic changes were identical between the two groups indicated similar intubation response suppression. The incidence of fentanyl-induced coughing was significantly lower in the optimized group ( 4/60) than in the control group ( 23/60) ( P < 0. 01). Conclusion Optimizing anesthetic injecting sequence during induction by separate fentanyl into two boluses significantly reduce fentanyl-induced coughing without affecting intubation response suppression.
