盐酸戊乙奎醚联合深呼吸法抑制麻醉诱导时芬太尼诱发咳嗽反应的有效性和安全性

发布时间：2018-01-16 03:12

  本文关键词：盐酸戊乙奎醚联合深呼吸法抑制麻醉诱导时芬太尼诱发咳嗽反应的有效性和安全性　出处：《中国现代医学杂志》2017年18期 　论文类型：期刊论文

  更多相关文章： 盐酸戊乙奎醚 深呼吸法 芬太尼诱发的咳嗽反应

【摘要】：目的探讨盐酸戊乙奎醚(PHC)联合深呼吸法抑制麻醉诱导时芬太尼诱发的咳嗽反应(FIC)的有效性和安全性。方法选取2015年9月-2016年9月该院行手术治疗的220例患者的临床资料,随机分为4组,每组55例。H组:于静脉注射芬太尼前10 min给予PHC 0.01 mg/kg,用生理盐水稀释成10 ml静脉注射。P组:芬太尼静脉注射前,患者完成3次深呼吸后立刻静脉注射芬太尼。M组:静脉推注芬太尼前10 min给予PHC0.01 mg/kg用生理盐水稀释成10 ml静脉注射,完成3次深呼吸后立即给予患者静脉注射芬太尼。N组:按照一定诱导顺序给予静脉快速诱导。记录患者静脉注射芬太尼后2 min内咳嗽出现的时间及严重程度,并计算咳嗽发生率;记录静脉注射芬太尼前10 min或静脉注射PHC(T_0)、静注芬太尼后1 min(T_1)、2 min(T2)的心率(HR)、收缩压(SBP)、舒张压(DBP)和脉搏血氧饱和度(SpO_2);并分别计算平均动脉压(MAP)。结果 4组患者咳嗽程度比较差异有统计学意义(χ~2=153.424,P=0.001);4组咳嗽发生时间比较差异有统计学意义(F=26.509,P=0.019)。4组患者FIC发生率差异有统计学意义(χ~2=12.488,P=0.006)。H组、P组、M组和N组FIC发生率分别为8例(14.5%)、7例(12.7%)、4例(7.3%)和17例(30.9%),将H组、P组和M组合并后,并与N组比较,差异有统计学意义(χ~2=11.337,P=0.001);4组患者HR、SpO_2及MAP在T_0、T_1和T_2时逐渐降低;T2时HR和MAP比T0时降低,差异有统计学意义(P0.5),T_0、T_1和T_2时间的SpO_2差异无统计学意义(P0.05)。4组不良反应发生率及不良反应比较无统计学意义(P0.05)。结论 PHC联合深呼吸法能有效抑制FIC的发生,优于单独使用PHC和深呼吸法,且对患者血流动力学影响小,不良反应少,安全性高。
[Abstract]:Objective to investigate the inhibition of fentanyl induced cough response (FICs) by pentehyclidine hydrochloride (PHCl) combined with deep breathing method in anesthetic induction. Methods the clinical data of 220 patients who underwent surgical treatment from September 2015 to September 2016 were selected. They were randomly divided into 4 groups, 55 cases in each group. Group H was given PHC 0. 01 mg/kg 10 min before intravenous injection of fentanyl. Group P was diluted with normal saline into 10 ml intravenous injection group: before fentanyl was injected intravenously. After three deep breaths, the patients in group M were injected with fentanyl immediately: 10 min before intravenous injection of fentanyl, PHC0.01 mg/kg was diluted into 10ml intravenous injection with normal saline. Immediately after 3 deep breaths, the patients were given intravenous fentanyl. N group: fast intravenous induction was given in a certain order. 2 fentanyl was recorded after intravenous fentanyl injection. The time and severity of cough in min. The incidence of cough was calculated. Heart rate was recorded 10 min before intravenous fentanyl injection or 1 min after intravenous injection of fentanyl. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse oxygen saturation (SPO _ 2); Results there were significant differences in cough degree among the 4 groups (蠂 ~ 2 153.424 P ~ (0.001)). There was significant difference in the occurrence time of cough among the 4 groups. There was significant difference in the incidence of FIC in the 4 groups (蠂 ~ 2 + 12.488). The incidence of FIC in P group (P group) and N group (P group) was 14.5 cases (n = 7) and 17 cases (n = 17). The difference between group H and group M was statistically significant compared with that of group N (蠂 2 + 11.337% P ~ (0.001)). HRO _ 2 and MAP in the four groups decreased gradually at the time of T0 / T _ (1) and T _ (2). HR and MAP at T2 were lower than those at T0, and the difference was statistically significant. There was no significant difference in SpO_2 between T _ 1 and T _ 2. There was no significant difference in the incidence of adverse reactions and adverse reactions in P0.05.4 group (P 0.05). Conclusion PHC combined with deep breathing can effectively inhibit the occurrence of FIC. It is superior to PHC and deep breathing alone, and has less hemodynamic effect, fewer adverse reactions and higher safety.
【作者单位】： 湖南省妇幼保健院麻醉科;
【分类号】：R614
【正文快照】： 芬太尼是临床麻醉中使用最多的药物,其起效快,镇痛效果强,作用时间短,心血管系统影响小[1]。麻醉诱导前静脉注射芬太尼后,常可见芬太尼诱发的咳嗽反应(fentanyl-induced cough,FIC)[2]。FIC发病率为18%~65%,常表现为短暂的、爆发性咳嗽[3]。FIC一旦爆发需要立即终止,有报道称，

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