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
6期
481-483,564
,共4页
余骏马%张野%陆姚%董春山%刘齐
餘駿馬%張野%陸姚%董春山%劉齊
여준마%장야%륙요%동춘산%류제
右美托咪定%异丙酚%芬太尼%舒芬太尼%呛咳
右美託咪定%異丙酚%芬太尼%舒芬太尼%嗆咳
우미탁미정%이병분%분태니%서분태니%창해
Dexmedetomidine%Propofol%Fentanyl%Sufentanil%Cough
目的 探讨右美托咪定(dexmedetomidine,DEX)联合异丙酚对等效剂量芬太尼和舒芬太尼诱发呛咳的影响.方法 200例拟行全麻气管插管的择期手术患者,美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级,年龄18岁～65岁,随机数字表法随机分为4组(每组50例):对照组(C1组、C2组)全麻诱导前静脉输注生理盐水0.15 ml/kg+脂肪乳0.1ml/kg;DEX联合异丙酚组(DP1组、DP2组)全麻诱导前静脉输注DEX 0.6 μg/kg+异丙酚1 mg/kg.1 min后,C1组、DP1组静脉5s注射芬太尼4μg/kg,C2组、DP2组静脉5s注射舒芬太尼0.5 μg/kg.记录注射芬太尼或舒芬太尼后1min内呛咳的发生情况和强度.之后继续全麻诱导及气管插管.记录各组静脉给药前(To)、气管插管前(T1)、气管插管后(T2)的收缩压(SBP)、舒张压(DBP)和心率(HR). 结果C1组、DP1组、C2组及DP2组呛咳发生率分别为:40％、0、24％、0.与C1组和C2组比较,DP1组、DP2组呛咳发生率明显降低(P＜0.01),但呛咳程度差异无统计学意义(P＞0.05).T1时,与C1组SBP[(94±13)mm Hg(1 mm Hg=0.133 kPa)]、DBP[(56±9) mm Hg]和C2组SBP[(92±14) mm Hg]、DBP[(55±10) mm Hg]比较,DP1组SBP[(114±13) mm Hg]、DBP[(70±10) mm Hg]和DP2组SBP[(116±15) mm Hg]、DBP[(72±10)mm Hg]升高(P＜0.01)；T1、T2时,与C1组HR[(68±11)次/min和(80±15)次/min]和C2组HR[(71±18)次/min和(84±17)次min]比较,DP1组HR[(62±11)次/min和(65±10)次/min]、DP2组HR[(61±8)次/min和(65±9) 次/min]降低(P＜0.01)；与T1时C1组SBP[(94±13) mm Hg]、DBP[(56±9)mm Hg]和C2组SBP[(92±14) mm Hg]、DBP[(55±10) mm Hg]比较,T2时C1组SBP[(122±22) mm Hg]、DBP[(76±16) mm Hg]和C2组SBP[(117±20) mm Hg]、DBP[(76±14) mm Hg]升高(P＜0.01). 结论静脉注射DEX 0.6 μg/kg联合异丙酚1 mg/kg可完全抑制等效剂量芬太尼和舒芬太尼诱发呛咳的发生,并可使患者全麻诱导气管插管期血流动力学更趋稳定.
目的 探討右美託咪定(dexmedetomidine,DEX)聯閤異丙酚對等效劑量芬太尼和舒芬太尼誘髮嗆咳的影響.方法 200例擬行全痳氣管插管的擇期手術患者,美國痳醉醫師協會(ASA)分級Ⅰ或Ⅱ級,年齡18歲～65歲,隨機數字錶法隨機分為4組(每組50例):對照組(C1組、C2組)全痳誘導前靜脈輸註生理鹽水0.15 ml/kg+脂肪乳0.1ml/kg;DEX聯閤異丙酚組(DP1組、DP2組)全痳誘導前靜脈輸註DEX 0.6 μg/kg+異丙酚1 mg/kg.1 min後,C1組、DP1組靜脈5s註射芬太尼4μg/kg,C2組、DP2組靜脈5s註射舒芬太尼0.5 μg/kg.記錄註射芬太尼或舒芬太尼後1min內嗆咳的髮生情況和彊度.之後繼續全痳誘導及氣管插管.記錄各組靜脈給藥前(To)、氣管插管前(T1)、氣管插管後(T2)的收縮壓(SBP)、舒張壓(DBP)和心率(HR). 結果C1組、DP1組、C2組及DP2組嗆咳髮生率分彆為:40％、0、24％、0.與C1組和C2組比較,DP1組、DP2組嗆咳髮生率明顯降低(P＜0.01),但嗆咳程度差異無統計學意義(P＞0.05).T1時,與C1組SBP[(94±13)mm Hg(1 mm Hg=0.133 kPa)]、DBP[(56±9) mm Hg]和C2組SBP[(92±14) mm Hg]、DBP[(55±10) mm Hg]比較,DP1組SBP[(114±13) mm Hg]、DBP[(70±10) mm Hg]和DP2組SBP[(116±15) mm Hg]、DBP[(72±10)mm Hg]升高(P＜0.01)；T1、T2時,與C1組HR[(68±11)次/min和(80±15)次/min]和C2組HR[(71±18)次/min和(84±17)次min]比較,DP1組HR[(62±11)次/min和(65±10)次/min]、DP2組HR[(61±8)次/min和(65±9) 次/min]降低(P＜0.01)；與T1時C1組SBP[(94±13) mm Hg]、DBP[(56±9)mm Hg]和C2組SBP[(92±14) mm Hg]、DBP[(55±10) mm Hg]比較,T2時C1組SBP[(122±22) mm Hg]、DBP[(76±16) mm Hg]和C2組SBP[(117±20) mm Hg]、DBP[(76±14) mm Hg]升高(P＜0.01). 結論靜脈註射DEX 0.6 μg/kg聯閤異丙酚1 mg/kg可完全抑製等效劑量芬太尼和舒芬太尼誘髮嗆咳的髮生,併可使患者全痳誘導氣管插管期血流動力學更趨穩定.
목적 탐토우미탁미정(dexmedetomidine,DEX)연합이병분대등효제량분태니화서분태니유발창해적영향.방법 200례의행전마기관삽관적택기수술환자,미국마취의사협회(ASA)분급Ⅰ혹Ⅱ급,년령18세～65세,수궤수자표법수궤분위4조(매조50례):대조조(C1조、C2조)전마유도전정맥수주생리염수0.15 ml/kg+지방유0.1ml/kg;DEX연합이병분조(DP1조、DP2조)전마유도전정맥수주DEX 0.6 μg/kg+이병분1 mg/kg.1 min후,C1조、DP1조정맥5s주사분태니4μg/kg,C2조、DP2조정맥5s주사서분태니0.5 μg/kg.기록주사분태니혹서분태니후1min내창해적발생정황화강도.지후계속전마유도급기관삽관.기록각조정맥급약전(To)、기관삽관전(T1)、기관삽관후(T2)적수축압(SBP)、서장압(DBP)화심솔(HR). 결과C1조、DP1조、C2조급DP2조창해발생솔분별위:40％、0、24％、0.여C1조화C2조비교,DP1조、DP2조창해발생솔명현강저(P＜0.01),단창해정도차이무통계학의의(P＞0.05).T1시,여C1조SBP[(94±13)mm Hg(1 mm Hg=0.133 kPa)]、DBP[(56±9) mm Hg]화C2조SBP[(92±14) mm Hg]、DBP[(55±10) mm Hg]비교,DP1조SBP[(114±13) mm Hg]、DBP[(70±10) mm Hg]화DP2조SBP[(116±15) mm Hg]、DBP[(72±10)mm Hg]승고(P＜0.01)；T1、T2시,여C1조HR[(68±11)차/min화(80±15)차/min]화C2조HR[(71±18)차/min화(84±17)차min]비교,DP1조HR[(62±11)차/min화(65±10)차/min]、DP2조HR[(61±8)차/min화(65±9) 차/min]강저(P＜0.01)；여T1시C1조SBP[(94±13) mm Hg]、DBP[(56±9)mm Hg]화C2조SBP[(92±14) mm Hg]、DBP[(55±10) mm Hg]비교,T2시C1조SBP[(122±22) mm Hg]、DBP[(76±16) mm Hg]화C2조SBP[(117±20) mm Hg]、DBP[(76±14) mm Hg]승고(P＜0.01). 결론정맥주사DEX 0.6 μg/kg연합이병분1 mg/kg가완전억제등효제량분태니화서분태니유발창해적발생,병가사환자전마유도기관삽관기혈류동역학경추은정.
Objective To investigate the effect of dexmedetomidine(DEX)-propofol in suppressing the response of cough by equipotent boluses of fentanyl and sufentanil.Methods A total of 200 patients of ASA Ⅰ or Ⅱ,aged 18 y-65 y undergoing elective surgery were randomized into four groups of 50 each,using computer-generated random numbers.Group C1 or Group C2:normal saline 0.15 ml/kg+intralipid 0.1 ml/kg,group DP1 or group DP2:DEX 0.6 μg/kg+propofol 1 mg/kg.1 min after receiving drugs mentioned before,patients in group C1 or group DP1 received iv.fentanyl (4 μg/kg) and patients in group C2 or group DP2 received iv sufentanil (0.5 μg/kg).After fentanyl administration,the onset time and the severity of cough for 1 min were recorded.Severity of coughing was graded as mild (1-2),moderate (3-5) and severe (＞5) based on the number of coughs.Induction of general anesthesia was continued with sufficient propofol and vecuronium 0.12 mg/kg,then tracheal intubation was performed by a practiced anesthesiologist.BP and HR were recorded before infusion (T0),before intubation (T1) and after intubation (T2).Results The incidence of coughing was higher in group C1 (20/50,40％) or group C2 (12/50,24％) than in group DP1 (0/50,P＜0.01) or group DP2 (0/50,P＜0.01).However,no difference in the severity of cough between group C1 and group C2 (P＞0.05).Conclusions With group C1-2,SBP and DBP of group DP1-2 was significantly increased in T1,[(94±13) mm Hg(1 mm Hg=0.133 kPa) and (92±14) mm Hg vs (114±13) mm Hg and (116±15) mm Hg; (56±9) mm Hg and (55±10) mm Hg vs (70±10) mm Hg and (72±10) mm Hg] (P＜0.01); but HR decreased significantly in T1-2 [(62±11) bpm and (65±10) bpm or (61±8) bpm and (65±9) bpm vs (68±11) bpm and (80± 15) bpm or (71 ± 18) bpm and (84± 17) bpm] (P＜0.01),Compared with T1,SBP and DBP of group C1-2 increased significantly in T2[(122±22) mm Hg vs (94±13) mm Hg and (117±20) mm Hg vs (92±14) mm Hg; (76±16) mm Hg vs (56±9) mm Hg and (76±14) mm Hg vs (55±10) mm Hg](P＜0.01).Conclusions Pretreatment DEX-propofol could completely suppress the response of cough by equipotent boluses of fentanyl and sufentanil,and the hemodynamics during general anesthesia induction and tracheal intubation were more stabler.
