CAJ | 학술논문

目的：观察盐酸纳美芬对芬太尼全麻诱导时发生呛咳的预防作用，以及在插管时对患者血流动力学的影响。方法将80例 ASA Ⅰ～Ⅱ级择期全麻手术患者随机分为两组，纳美芬组（Ⅰ组）和对照组（Ⅱ组），2组患者诱导前30 min 常规肌肉注射苯巴比妥钠30 mg，阿托品0．5 mg。Ⅰ组患者在诱导前2 min 静脉注射盐酸纳美芬0．25μg /kg，Ⅱ组静脉注射等容量的生理盐水，观察2组患者静注芬太尼后60 s 内发生呛咳例数（发生率）及发生的强度，记录在麻醉诱导前（T0），静注芬太尼后60 s 时（T1），插管后即刻（T2）患者的血压、心率和外周血氧饱和度。结果Ⅰ组呛咳的发生率为0％，Ⅱ组为60％，Ⅰ组与Ⅱ组呛咳发生率比较差异有统计学意义（P ＜0．05），Ⅰ组与Ⅱ组呛咳强度比较差异有统计学意义（P ＜0．05），Ⅰ组与Ⅱ组相比静注芬太尼60 s 时患者血流动力学差异显著（P ＜0．05），而2组患者对插管时血流动力学影响差异不显著（P ＞0．05）。结论预防性注射盐酸纳美芬可有效减少芬太尼麻醉诱导期患者呛咳反应的发生率和呛咳的程度，并减少因呛咳反应所造成的血流动力学不稳定，但是对患者的插管反应无影响。
목적：관찰염산납미분대분태니전마유도시발생창해적예방작용，이급재삽관시대환자혈류동역학적영향。방법장80례 ASA Ⅰ～Ⅱ급택기전마수술환자수궤분위량조，납미분조（Ⅰ조）화대조조（Ⅱ조），2조환자유도전30 min 상규기육주사분파비타납30 mg，아탁품0．5 mg。Ⅰ조환자재유도전2 min 정맥주사염산납미분0．25μg /kg，Ⅱ조정맥주사등용량적생리염수，관찰2조환자정주분태니후60 s 내발생창해례수（발생솔）급발생적강도，기록재마취유도전（T0），정주분태니후60 s 시（T1），삽관후즉각（T2）환자적혈압、심솔화외주혈양포화도。결과Ⅰ조창해적발생솔위0％，Ⅱ조위60％，Ⅰ조여Ⅱ조창해발생솔비교차이유통계학의의（P ＜0．05），Ⅰ조여Ⅱ조창해강도비교차이유통계학의의（P ＜0．05），Ⅰ조여Ⅱ조상비정주분태니60 s 시환자혈류동역학차이현저（P ＜0．05），이2조환자대삽관시혈류동역학영향차이불현저（P ＞0．05）。결론예방성주사염산납미분가유효감소분태니마취유도기환자창해반응적발생솔화창해적정도，병감소인창해반응소조성적혈류동역학불은정，단시대환자적삽관반응무영향。
Objective To explore the role of nalmefene in prevention of fentanyl-induced bucking in patients with induction of general anesthesia and observe its influence on hemodynamic during intubation.Methods 80 patients with ASA ⅠtoⅡ were randomly divided into nalmefene group (group Ⅰ)and the control group (group Ⅱ).All patients were injected with phenobarbital sodium 30 mg and atropine 0.5 mg 30 minutes before induction of anesthesia.0.25 μg /kg of hy-drochloric acid natrium nalmene and the same capacity of physiological saline was applied 2 minutes before induction of intravenous for group Ⅱ and Ⅰ respectively.Coughing cases (incidence)and the intensity,blood pressure,heart rate ,pulse oxygen saturation before anesthesia induction,60 second after fentanyl injection and after intubation were observe between two groups.Results In-cidence rate of cough was 0% in group Ⅰ,which was significantly lower than 60% in group Ⅱ(P < 0 .0 5 ).Strength of coughing in group Ⅱ was much more intensive than that in group Ⅰ(P <0.05).The hemodynamic parameters after fentanyl injection in group Ⅰ was more steady than that in group Ⅱ (P <0.05),and there was no significant difference of hemodynamic response to intubation between two groups (P >0.05).Conclusion Preventive injection of nalmefene can effectively prevent coughing response to fentanyl injection during induction of anesthesia and im-prove the hemodynamic instability.