优化全麻诱导用药预防患者芬太尼呛咳反应的观察

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.

Effect of optimizing anesthetic injecting sequence during induction on fentanyl-induced coughing

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.