不同给药方法对舒芬太尼咳嗽反应的影响

目的比较不同方法快诱导全麻对减轻舒芬太尼诱发咳嗽反应的影响。方法 200例ASAI或Ⅱ级患者随机均分为4组,麻醉诱导方法分别为：Ⅰ组（对照组）依次静脉注射咪达唑仑0.05mg/kg、舒芬太尼0.4μg/kg、异丙酚1.5mg/kg、罗库溴胺1mg/kg;Ⅱ组（预注组）依次静脉注射咪达唑仑0.05mg/kg、舒芬太尼0.1μg/kg、异丙酚1.5mg/kg、罗库溴胺1mg/kg、舒芬太尼0.3μg/kg,Ⅲ组（稀释组）依次静脉注射咪达唑仑0.05mg/kg、舒芬太尼0.4μg/kg（2.5μg/mL）、异丙酚1.5mg/kg、罗库溴胺1mg/kg;Ⅳ组（后注射组）依次静脉注射咪达唑仑0.05mg/kg、异丙酚1.5mg/kg、罗库溴胺1mg/kg、舒芬太尼0.4μg/kg;除组Ⅲ外其余3组舒芬太尼浓度为10μg/mL。4组患者于诱导后2min进行气管插管,观察插管前咳嗽反应的发生率及严重程度,记录诱导前、诱导后、咳嗽时、插管时的SpO2、ABP和HR。结果 4组患者咳嗽的发生率Ⅱ组为8%（4/50）,Ⅲ组为10%（5/50）,Ⅳ组为2%（1/50）,Ⅱ、Ⅲ、Ⅳ组明显低于Ⅰ组的38%（19/50）（P〈0.01）,Ⅱ、Ⅲ组低于Ⅳ组（P〈0.05）;4组患者T1、T2、T3、T4时间点的SBP和HR差异无统计学意义;T3的SBP、HR均较T1、T2明显升高（P〈0.01）。结论快速诱导全身麻醉时舒芬太尼最后给药、稀释给药或给予预注剂量均可以明显降低舒芬太尼诱发咳嗽反应的发生率,其中以最后给药效果最佳。

Different usage of sufentanyl during anesthesia induction on sufentanyl-induced cough

Objective To compare the effect of the different usage of sufentanyl during anesthesia induction on sufentanyl-induced cough.Methods Two hundreds patients undergoing general anesthesia,ASAⅠor Ⅱ,were randomlmLy divided into four groups,the anesthesia induction methods respectively is：groupⅠ（control group） successively intravenous inject midazolam 0.05 mg/kg,sufentanyl 0.4 μg/kg,propofol 1.5 mg/kg,rocuronium 1 mg/kg;groupⅡ（pre-injection group） successively intravenous inject midazolam 0.05 mg/kg,sufentanyl 0.1 μg/kg,propofol 1.5 mg/kg,rocuronium 1 mg/kg,fentanyl 0.3 μg/kg;group Ⅲ（dilution group） successively intravenous inject midazolam 0.05 mg/kg,sufentanyl 0.4 μg/kg（2.5 μg/mL）,propofol 1.5 mg/kg,rocuronium 1 mg/kg;group Ⅳ（last injection group） successively intravenous inject midazolam 0.05 mg/kg,propofol 1.5 mg/kg,rocuronium 1 mg/kg,sufentanyl 0.4 μg/kg,sufentanyl concentration is 10 μg/mL in each group except group Ⅲ.2 min after the induction,All patients were intubated.The incidence and severity of cough before intubation were recorded,SBP and HR were observed at time before induction（T1）,after induction（T2）,coughing（T3）,intubation（T4）.Results The incidence of cough respectively was 7.6% in group Ⅱ,9.5% in group Ⅲ,1.9% in group Ⅳ,which was significantly lower than the 35.2% in group Ⅰ（P0.01）,Group Ⅳwas significantly lower than that in groupⅡand Ⅲ（P0.05）;SBP and HR were no significant differences in T1,T2,T3,T4 between four groups of patients;In four groups of patients,ABP and HR at coughing（T3） were significantly higher than that at T1,T2（P0.01）.Conclusion The different usage of sufentanyl,such as sufentanyl last injection、pre-injection、dilution can significantly reduce the incidence of cough during anesthesia induction,in which the last injection has the best effect.