盐酸纳美芬对心脏手术全麻诱导期舒芬太尼诱发呛咳的预防作用

目的:观察盐酸纳美芬对舒芬太尼于心脏手术全麻诱导时发生呛咳的预防作用,以及在插管时对病人血流动力学的影响.方法:将60例ASAⅡ~Ⅲ 级择期心脏手术病人随机分为纳美芬组(N组)和对照组(C组),2组病人术前2 h地西泮10 mg口服,术前30 min东莨菪碱0.3 mg肌内注射.N组病人在诱导前5 min 静脉注射(静注)盐酸纳美芬0.25 μg/kg,C组静注等容量的0.9%氯化钠注射液,观察2组病人在常规诱导时静注舒芬太尼后60 s内发生呛咳例数及发生的强度,记录在静注纳美芬前(T0)、麻醉诱导前(T1)、静注舒芬太尼60 s时(T2)和气管插管即刻(T3)的病人生命体征变化情况.结果:N组病人的呛咳发生率为10.00%,明显低于C组发生率60.00%(P<0.01);N组与C组呛咳强度差异有统计学意义(P<0.05).2组T2血流动力学变化血压、心率和脑电双频指数差异有统计学意义(P<0.05),而血氧饱和度差异无统计学意义(P>0.05) ,且2组病人T3血流动力学影响差异无统计学意义(P>0.05).结论:预防性注射盐酸纳美芬可有效减少舒芬太尼于心脏麻醉诱导期病人呛咳反应的发生率和强度,减少因呛咳反应所造成的血流动力学波动,但对病人的插管反应无影响.

Preventive effect of nalmefene hydrochloride on the sufentanil-induced cough during induction of general anesthesia in cardiac surgery

Objective:To explore the preventive effects of nalmefene hydrochloride on the sufentanil-induced cough(SFIC) during induction of general anesthesia in cardiac surgery,and hemodynamics change during intubation.Methods:Sixty patients with ASA grade Ⅱ to Ⅲ scheduled by operation were randomly divided into the nalmefene group(group N) and control group(group C).Two groups were treated with 10 mg of diazepam by oral before 2 hours of operation and 0.3 mg of scopolamine by intramuscular injection before 30 minutes of operation.Group N and group C were intravenously injected with 0.25 μg/kg of nalmefene hydrochloride and the same volume of 0.9% sodium chloride 5 minutes before induction,respectively.The incidence rate and intensity of cough within 60 s in the intravenously injection of sufentanil in two groups were observed.The vital signs of two groups were recorded before the nalmefene injection(T0),before anesthesia induction(T1),at 60 s of sufentanil injection(T2) and intubation(T3).Results:The incidence rates of cough in group N and group C were 10.00% and 60.00%,respectively,the difference of which was statistically significant(P<0.01).The difference of the cough intensity between two groups was statistically significant(P<0.05).The differences of the hemodynamics,heart rate and bispectral index at T2 between two groups were statistically significant(P<0.05),the difference of the oxygen saturation at T2 between two groups was not statistically significant(P>0.05),and the difference of the hemodynamics at T3 between two groups was not statistically significant(P>0.05).Conclusions:Preventive injection of nalmefene can effectively reduce the incidence rate and intensity of sufentanil-induced cough during induction of general anesthesia in cardiac surgery,and the hemodynamic fluctuation caused by cough,which do not affect the reaction of intubation.