国际麻醉学与复苏杂志
國際痳醉學與複囌雜誌
국제마취학여복소잡지
INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
2013年
12期
1090-1093
,共4页
史长喜%茆庆洪%李青%阮加萍%刘向荣%柳胜安%孙运乾
史長喜%茆慶洪%李青%阮加萍%劉嚮榮%柳勝安%孫運乾
사장희%묘경홍%리청%원가평%류향영%류성안%손운건
右美托咪定%肌肉注射%芬太尼%咳嗽
右美託咪定%肌肉註射%芬太尼%咳嗽
우미탁미정%기육주사%분태니%해수
Dexmedetomidine%Intramuscular injection%Fentanyl%Cough
目的 观察全麻诱导前肌肉注射不同剂量右美托咪定(dexmedetomidine,DEX)对芬太尼诱发咳嗽反射的影响. 方法 200例美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级择期手术患者,完全随机分为对照组(C组)和DEX组(D1组、D2组、D3组)4组,每组50例.诱导前D1组、D2组、D3组分别肌肉注射DEX 1、1.5、2μg/kg,C组肌肉注射等容量的生理盐水.15 min后静脉注射芬太尼3μg/kg,过1 min后静脉注射异丙酚2 mg/kg、罗库溴铵0.6 mg/kg行快速诱导气管插管.记录注射DEX前(T0)、注射芬太尼前(T1)、插管前即刻(T2)、插管后即刻(T3)、插管后1 min(T4)、插管后3 min(T5)、插管后5 min(T6)的收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、平均动脉压(mean artery pressure,MAP)、心率(heart rate,HR)以及咳嗽反射情况. 结果 D1组、D2组、D3组咳嗽反射的发生率(分别为8％、6％、4％)明显低于C组(32％)(P＜0.01);D1组、D2组、D3组之间咳嗽反射的发生率比较差异无统计学意义(P＞0.05);各组T1时点MAP、HR [(89±10)、(91±11)、(94±9)、(90±9)mm Hg(1 mm Hg=0.133 kPa),(68±9)、(70±10)、(68±8)、(70±12)次/min]与T0时点MAP、HR[(91±8)、(89±10)、(92±8)、(88±9)mmHg,(73±11)、(74±9)、(71±7)、(72±8)次/min]比较差异无统计学意义(P＞0.05);与T0时点MAP、HR[(91±8)、(89±10)、(92±8)、(88±9) mm Hg,(73±11)、(74±9)、(71±7)、(72±8)次/min]比较,各组T2时点MAP、HR[(80±8)、(78±10)、(71±9)、(69±9) mm Hg,(64±9)、(65±10)、(58±7)、(56±8)次/min]明显降低(P＜0.05);T2时点D2组、D3组MAP、HR[(71±9)、(69±9) mm Hg,(58±7)、(56±8)次/min]低于C组、D1组[(80±8)、(78±10) mm Hg,(64±9)、(65±10)次/min] (P＜0.05);诱导后D3组有11例(22％)发生低血压,明显高于C组[2例(4％)](P＜0.01);D2、D3组分别有10例(20％)和12例(24％)发生心动过缓,明显高于C组[1例(2％)](P＜0.01);D1组、C组之间低血压和心动过缓的发生率比较差异无统计学意义(P＞0.05). 结论 全麻诱导前预先肌肉注射小剂量(1 μg/kg)DEX能显著减少芬太尼诱发咳嗽反射的发生率,且对诱导期间血流动力学无明显影响.
目的 觀察全痳誘導前肌肉註射不同劑量右美託咪定(dexmedetomidine,DEX)對芬太尼誘髮咳嗽反射的影響. 方法 200例美國痳醉醫師協會(ASA)分級Ⅰ～Ⅱ級擇期手術患者,完全隨機分為對照組(C組)和DEX組(D1組、D2組、D3組)4組,每組50例.誘導前D1組、D2組、D3組分彆肌肉註射DEX 1、1.5、2μg/kg,C組肌肉註射等容量的生理鹽水.15 min後靜脈註射芬太尼3μg/kg,過1 min後靜脈註射異丙酚2 mg/kg、囉庫溴銨0.6 mg/kg行快速誘導氣管插管.記錄註射DEX前(T0)、註射芬太尼前(T1)、插管前即刻(T2)、插管後即刻(T3)、插管後1 min(T4)、插管後3 min(T5)、插管後5 min(T6)的收縮壓(systolic blood pressure,SBP)、舒張壓(diastolic blood pressure,DBP)、平均動脈壓(mean artery pressure,MAP)、心率(heart rate,HR)以及咳嗽反射情況. 結果 D1組、D2組、D3組咳嗽反射的髮生率(分彆為8％、6％、4％)明顯低于C組(32％)(P＜0.01);D1組、D2組、D3組之間咳嗽反射的髮生率比較差異無統計學意義(P＞0.05);各組T1時點MAP、HR [(89±10)、(91±11)、(94±9)、(90±9)mm Hg(1 mm Hg=0.133 kPa),(68±9)、(70±10)、(68±8)、(70±12)次/min]與T0時點MAP、HR[(91±8)、(89±10)、(92±8)、(88±9)mmHg,(73±11)、(74±9)、(71±7)、(72±8)次/min]比較差異無統計學意義(P＞0.05);與T0時點MAP、HR[(91±8)、(89±10)、(92±8)、(88±9) mm Hg,(73±11)、(74±9)、(71±7)、(72±8)次/min]比較,各組T2時點MAP、HR[(80±8)、(78±10)、(71±9)、(69±9) mm Hg,(64±9)、(65±10)、(58±7)、(56±8)次/min]明顯降低(P＜0.05);T2時點D2組、D3組MAP、HR[(71±9)、(69±9) mm Hg,(58±7)、(56±8)次/min]低于C組、D1組[(80±8)、(78±10) mm Hg,(64±9)、(65±10)次/min] (P＜0.05);誘導後D3組有11例(22％)髮生低血壓,明顯高于C組[2例(4％)](P＜0.01);D2、D3組分彆有10例(20％)和12例(24％)髮生心動過緩,明顯高于C組[1例(2％)](P＜0.01);D1組、C組之間低血壓和心動過緩的髮生率比較差異無統計學意義(P＞0.05). 結論 全痳誘導前預先肌肉註射小劑量(1 μg/kg)DEX能顯著減少芬太尼誘髮咳嗽反射的髮生率,且對誘導期間血流動力學無明顯影響.
목적 관찰전마유도전기육주사불동제량우미탁미정(dexmedetomidine,DEX)대분태니유발해수반사적영향. 방법 200례미국마취의사협회(ASA)분급Ⅰ～Ⅱ급택기수술환자,완전수궤분위대조조(C조)화DEX조(D1조、D2조、D3조)4조,매조50례.유도전D1조、D2조、D3조분별기육주사DEX 1、1.5、2μg/kg,C조기육주사등용량적생리염수.15 min후정맥주사분태니3μg/kg,과1 min후정맥주사이병분2 mg/kg、라고추안0.6 mg/kg행쾌속유도기관삽관.기록주사DEX전(T0)、주사분태니전(T1)、삽관전즉각(T2)、삽관후즉각(T3)、삽관후1 min(T4)、삽관후3 min(T5)、삽관후5 min(T6)적수축압(systolic blood pressure,SBP)、서장압(diastolic blood pressure,DBP)、평균동맥압(mean artery pressure,MAP)、심솔(heart rate,HR)이급해수반사정황. 결과 D1조、D2조、D3조해수반사적발생솔(분별위8％、6％、4％)명현저우C조(32％)(P＜0.01);D1조、D2조、D3조지간해수반사적발생솔비교차이무통계학의의(P＞0.05);각조T1시점MAP、HR [(89±10)、(91±11)、(94±9)、(90±9)mm Hg(1 mm Hg=0.133 kPa),(68±9)、(70±10)、(68±8)、(70±12)차/min]여T0시점MAP、HR[(91±8)、(89±10)、(92±8)、(88±9)mmHg,(73±11)、(74±9)、(71±7)、(72±8)차/min]비교차이무통계학의의(P＞0.05);여T0시점MAP、HR[(91±8)、(89±10)、(92±8)、(88±9) mm Hg,(73±11)、(74±9)、(71±7)、(72±8)차/min]비교,각조T2시점MAP、HR[(80±8)、(78±10)、(71±9)、(69±9) mm Hg,(64±9)、(65±10)、(58±7)、(56±8)차/min]명현강저(P＜0.05);T2시점D2조、D3조MAP、HR[(71±9)、(69±9) mm Hg,(58±7)、(56±8)차/min]저우C조、D1조[(80±8)、(78±10) mm Hg,(64±9)、(65±10)차/min] (P＜0.05);유도후D3조유11례(22％)발생저혈압,명현고우C조[2례(4％)](P＜0.01);D2、D3조분별유10례(20％)화12례(24％)발생심동과완,명현고우C조[1례(2％)](P＜0.01);D1조、C조지간저혈압화심동과완적발생솔비교차이무통계학의의(P＞0.05). 결론 전마유도전예선기육주사소제량(1 μg/kg)DEX능현저감소분태니유발해수반사적발생솔,차대유도기간혈류동역학무명현영향.
Objective To investigate the effect of pretreatment of intramuscular dexmedetomidine(DEX) on the incidence of fentanyl-induced cough on general anesthesia patients.Methods 200 patients,ASA Ⅰ-Ⅱ,were randomly allocated into four groups (group C,D1,D2 and D3,n=50).Patients in group D1,D2 and D3 were administered intramuscularly DEX 1,1.5,2 μg/kg,respectively,and the patients in group C were injected with an isovolumic saline.15 min later,all patients of the 4 groups received intravenous fentanyl 3 pg/kg,and 1 min subsequently,propofol 2 mg/kg and rocuronium 0.6 mg/kg were injected intravenously for anesthetic induction.Noninvasive blood pressure and heart rate were recorded at the following time points:before DEX administration (T0),before fentanyl administration (T1),instantly before intubation (T2),instantly after intubation (T3),1 min after i ntubation (T4),3 min after intubation (T5),and 5 min after intubation (T6).The incidence and severity of cough within 1 min after fentanyl administration were also recorded.Results The incidences of cough in group D1,D2 and D3 were 8％,6％ and 4％ respectively,which were significantly lower than that in group C(32％)(P＜0.01),while there were no remarkable differences among group D1,D2 and D3(P＞0.05).Among the four groups,there were no significant differences in mean artery pressure(MAP) and heart rate(HR) at T1 compared with those at T0[(89±10),(91±11),(94±9),(90±9) mm Hg(1 mm Hg=0.133 kPa).(68±9),(70±10),(68±8),(70±12)bpmvs (91±8),(89±10),(92±8),(88±9) mm Hg.(73±11),(74±9),(71±7),(72±8) bpm](P＞0.05).MAP and HR at T2 were lower than those at T0 among the four groups[(80±8),(78±10),(71±9),(69±9) mm Hg.(64±9),(65±10),(58±7),(56±8) bpm vs (91±8),(89±10),(92±8),(88±9) mm Hg.(73±11),(74±9),(71±7),(72±8) bpm](P＜0.05).MAP and HR at T2 were lower in group D2 and D3 than those in group C and D1 [(71 ±9),(69±9) mm Hg.(58±7),(56±8) bpm vs (80±8),(78± 10) mm Hg.(64±9),(65±10) bpm](P＜0.05).The incidence of severe low blood pressure in group D3 was higher than that in group C(22％ vs 4％,P＜0.01),and the incidences of severe sinus bradycardia in group D2 and D3 were higher than that in group C (20％ and 24％ vs 2％,P＜0.01),while there was no significant difference in severe low blood pressure and sinus bradycardia between group C and group D1 (P＞0.05).Conclusions Pretreatment with low dose (1 μg/kg) of intramuscular DEX significantly reduced the incidence of fentanyl-induced cough without significant hemodynamic changes during induction of general anesthesia.
