盐酸异丙嗪对芬太尼诱发咳嗽的影响
发布时间：2018-07-21 12:08
【摘要】：背景与目的：全身麻醉诱导期间静脉注射芬太尼诱发咳嗽(Fentanylinduced cough,FIC)可大大增加诱导期风险。临床有许多方法和药物可以抑制FIC，但都不是很理想。临床常用的镇咳药异丙嗪能否抑制FIC，目前未见报道。本实验拟观察静脉注射小剂量抗组胺药盐酸异丙嗪对FIC的影响，寻找新的抑制FIC的方法，以减少或避免全身麻醉诱导期间FIC。观察全麻诱导期间注射芬太尼后血浆组胺浓度的变化以及预注异丙嗪对芬太尼后血浆组胺浓度的影响，探讨组胺在FIC发生中的作用以及异丙嗪是否通过抑制组胺的释放而发挥作用。 方法：第一部分：采用随机对照双盲实验，选200例拟行全身麻醉下择期手术患者，术前随机分为4组：对照组和实验1、2、3组。麻醉诱导前各组分别给予0.1ml/kg的4种药液：0.9%NS，0.5mg/ml异丙嗪，1mg/ml异丙嗪和1.5mg/ml异丙嗪。所有患者麻醉诱导以50μg/s的速度静脉注射芬太尼3μg/kg，2min后给予丙泊酚1-1.5mg/kg、顺式阿曲库铵0.2mg/kg。吸入1-1.5MAC七氟醚、静脉泵注瑞芬太尼0.1-0.2μg/kg/min、顺式阿曲库铵0.3mg/kg/h维持麻醉与肌松。注射芬太尼2min内记录患者咳嗽发生情况，包括咳嗽发生时间、次数、强度，记录预注异丙嗪前（T0）、静注芬太尼前（T1）、气管插管前（T3）、气管插管后（T4）血压和心率值，术后记录手术结束至拔除气管导管的时间，术后恶心呕吐的发生情况。第二部分：根据第一部分实验结果选择实验组2所用异丙嗪的剂量继续实验。选30例胆石胆囊炎拟在全麻腹腔镜下行胆囊切除的患者随机分为两组，芬太尼组（F组）和异丙嗪+芬太尼组（FP组）：分别给予3μg/kg芬太尼和0.1ml/kg异丙嗪（1mg/ml）+3μg/kg芬太尼，麻醉方法同前。给药前（t0）、给药后2min（t1）、气管插管后2min（t2）外周静脉血2ml，测定血浆组胺浓度。 结果：第一部分：（1）4组患者一般资料：年龄、性别、体重、身高、所患疾病及学科无显著性差异（p0.05）。 （2）4组患者血压心率变化：各组收缩压、舒张压和心率在T0、T1、T2和T3时点差异无统计学意义（p0.05），T4时点对照组、实验2组、3组的舒张压升高较实验1组明显，差异有统计学意义（p0.05），实验3组心率增快高于对照组和实验1、2组，差异有统计学意义（p0.05）。组内比较：各组T3时点心率、收缩压、舒张压均明显低于T0、T1、T2和T4，差异有统计学意义（p0.05），而各组内心率、收缩压、舒张压在T0、T1、T2和T4差异无统计学意义（p0.05）。 （3）4组患者FIC发生率：对照组FIC发生16例（32%），其中轻、中、重度分别为11、3、2例。实验1组FIC发生8例（16%），其中轻、中、重度分别为4、2、2例。实验2组FIC发生6例（12%），其中轻、中、重度分别为1、2、3例。实验3组FIC发生5例（10%），，其中轻、中、重度分别为2、0、3例。实验1组、2组、3组总咳嗽发生率与对照组相比均明显下降，差异有统计学意义（p0.05）；轻度FIC发生率实验1组、2组、3组比对照组明显下降，差异有统计学意义（p0.05）；FIC中度和重度发生率各组比较差异无统计学意义（p0.05）。组内比较：对照组内FIC轻度发生率明显高于中度和重度发生率，差异有统计学意义（p0.05），中度和重度没有显著性差别（p0.05）。实验1组、2组、3组内轻、中、重度发生率比较统计学无显著差异（p0.05）。 （4）4组发生FIC的平均时间：分别为：12.60s、12.89s、13.36s、12.25s，4组比较无显著差异（p0.05）。 （5）4组患者苏醒拔管的时间：对照组、实验1组、2组、3组患者手术结束停止所有麻醉药至苏醒拔除气管导管的时间分别为：7.40±1.80min、7.52±1.81min、7.44±1.89min、7.32±2.11min，四组患者苏醒拔除气管导管时间差异无统计学意义（p0.05）。 （6）术后恶心呕吐、咳嗽咯痰的发生情况：对照组、实验1组、2组、3组分别为：1、1、1和2例；术后咳痰的发生情况：对照组、实验1组、2组、3组分别为：7、10、4和4例。4组患者术后恶心呕吐、咳嗽咯痰发生率统计学无显著性差异（p0.05）。第二部分：（1）两组患者一般资料无统计学差异（p0.05）。（2）芬太尼组（F组）t0、t1、t2静脉血浆组胺浓度分别为：8.53±2.04ng/ml、7.24±2.14ng/ml、7.57±1.83ng/ml；异丙嗪+芬太尼组（FP组）静脉血浆组胺浓度分别为：8.23±2.58ng/ml、7.33±1.89ng/ml、7.23±2.02ng/ml，两组组内及组间比较均无显著差异（p0.05）。 结论：（1）预注0.05mg/kg、0.1mg/kg、0.15mg/kg盐酸异丙嗪可降低FIC的发生率。3种剂量对麻醉诱导期间血压有轻度的影响而对心率、术后苏醒拔除气管导管时间、术后并发症无明显影响。 （2）麻醉诱导以50μg/s的速度注射浓度为50μg/ml芬太尼3μg/kg不影响血浆组胺浓度的变化，预注0.1mg/kg异丙嗪对注射芬太尼后血浆组胺浓度的变化也无显著影响。
[Abstract]:Background and objective: intravenous fentanyl induced cough (Fentanylinduced cough, FIC) during induction of general anesthesia can greatly increase the risk of induction. There are many clinical methods and drugs that can inhibit FIC, but they are not ideal. The clinical antitussive drug, promethazine, can inhibit FIC. This experiment is to observe intravenous injection. The effect of promethazine hydrochloride, a small dose of antihistamine, on FIC, in order to find a new method of inhibiting FIC, in order to reduce or avoid the changes in the plasma histamine concentration after injection of fentanyl during induction of general anesthesia induction during induction of general anesthesia and the effect of preinjection of Promethazine on the concentration of histamine after fentanyl, and to explore the role of histamine in the occurrence of FIC. And whether promethazine can play a role in inhibiting histamine release.
Methods: in the first part, 200 patients undergoing elective surgery under general anesthesia were randomly divided into 4 groups before operation: control group and experimental group 1,2,3. Before anesthesia induction, 4 kinds of 0.1ml/kg solution were given to each group: 0.9%NS, 0.5mg/ml promethazine, 1mg/ml isopromethazine and 1.5mg/ml isopromethazine. All patients were induced by anesthesia induction. At the speed of 50 mu g/s, fentanyl was injected 3 u g/kg, 2min was given 1-1.5mg/kg, CIS atracurium 0.2mg/kg. inhaled 1-1.5MAC sevoflurane, intravenous infusion of remifentanil 0.1-0.2 u g/kg/min, CIS atracurium 0.3mg/kg/h maintenance anesthesia and muscle relaxation. The occurrence of coughing in patients with fentanyl 2min was recorded, including coughing. Interval, times, intensity, recording pre injection of promethazine (T0), intravenous injection of fentanyl (T1), pretracheal intubation (T3), blood pressure and heart rate after endotracheal intubation (T4), the time after operation to remove tracheal catheter and postoperative nausea and vomiting. Second part: select the 2 promethazine agent in the experimental group according to the results of the first part of the experiment. 30 cases of gallstone cholecystitis were randomly divided into two groups, the fentanyl group (group F) and the promethazine + fentanyl group (group FP): 3 mu g/kg fentanyl and 0.1ml/kg isopromethazine (1mg/ml) +3 mu g/kg fentanyl respectively, the anesthesia method was the same before. Before administration (T0), after the administration, the tracheal intubation 2min (T2) 2ml was measured in peripheral venous blood and plasma histamine concentration was measured.
Results: the first part: (1) general information of 4 groups of patients: age, sex, weight, height, disease and subjects were not significantly different (P0.05).
(2) the change of blood pressure and heart rate in the 4 groups: there was no significant difference in systolic pressure, diastolic pressure and heart rate in T0, T1, T2 and T3 (P0.05), T4 time point control group, experiment 2 group, and the 3 groups were significantly higher than the experimental group 1, the difference was statistically significant (P0.05), the rate of heart rate in the 3 groups was higher than that of the control group and the experimental 1,2 group, the difference was statistically significant P0.05. In group comparison, the rate of dessert, systolic pressure and diastolic pressure were significantly lower than that of T0, T1, T2 and T4 (P0.05), but there was no significant difference in the heart rate, systolic pressure and diastolic pressure in T0, T1, T2 and T4 (P0.05) in each group (T3).
(3) the incidence of FIC in the 4 groups: 16 cases of FIC in the control group (32%), with light, medium and severe 11,3,2 respectively. 8 cases (16%) occurred in the 1 group of FIC, of which the light, middle and severe cases were 4,2,2 respectively. The 2 groups were 6 (12%) in the experiment, of which the mild, middle and severe cases were respectively 1,2,3 cases. The experimental group of FIC occurred in 5 cases (10%), of which the light, medium, and severe cases were 2,0,3 cases respectively. The 1 groups, 2 groups, 3 groups of total coughing compared with the control group decreased significantly compared with the control group, the difference was statistically significant (P0.05); the mild FIC incidence of experimental 1, 2 groups, 3 groups were significantly lower than the control group, the difference was statistically significant (P0.05); the incidence of moderate and severe incidence of FIC was not statistically significant (P0.05). Group comparison: control group: control group: comparison group: control group: control group The mild incidence of internal FIC was significantly higher than the moderate and severe incidence, the difference was statistically significant (P0.05). There was no significant difference between moderate and severe (P0.05). There was no significant difference between the 1 groups in the experimental group, the 2 groups, and the moderate and severe incidence in the 3 groups (P0.05).
(4) the average time of occurrence of FIC in the 4 groups was 12.60s, 12.89s, 13.36s and 12.25s respectively, and there was no significant difference between the 4 groups (P0.05).
(5) the time of 4 groups of patients awakened and extubation: the control group, the experiment 1 groups, the 2 groups, the 3 groups of patients to stop all the anesthetic to the recovery of the tracheal tube time were 7.40 + 1.80min, 7.52 + 1.81min, 7.44 + 1.89min, 7.32 + 2.11min, four groups of patients to wake up the extraction of tracheal catheter time difference was not statistically significant (P0.05).
(6) postoperative nausea and vomiting, cough and phlegm: control group, experimental 1 groups, 2 groups, 3 groups, 1,1,1 and 2 cases; postoperative expectoration: control group, 1 groups, 2 groups, 3 groups of patients with postoperative nausea and vomiting, cough, cough and sputum incidence of no significant difference (P0.05). Second: Second: Second: (1) The general data of the two groups were not statistically different (P0.05). (2) the concentration of histamine in the venous plasma of the fentanyl group (group F) was 8.53 + 2.04ng/ml, 7.24 + 2.14ng/ml, 7.57 + 1.83ng/ml, and the concentration of histamine in the venous plasma of promethazine + fentanyl group (group FP) was 8.23 + 2.58ng/ml, 7.33 + and 7.23 + 2.02ng/ml, in and between the two groups and groups. There was no significant difference in the comparison (P0.05).
Conclusion: (1) pre injection of 0.05mg/kg, 0.1mg/kg, 0.15mg/kg promethazine hydrochloride can reduce the incidence of FIC,.3 dose has a slight effect on the blood pressure during the induction of anesthesia, and the time of the tracheal catheter removal after the operation, and the postoperative complications have no obvious effect.
(2) the change of plasma histamine concentration was not affected by the velocity injection of 50 mu g/s at the concentration of 50 mu g/ml fentanyl 3 u g/kg, and there was no significant effect on the change of plasma histamine concentration after injection of promethazine after injection of fentanyl.
【学位授予单位】：泸州医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614
本文编号：2135474
[Abstract]:Background and objective: intravenous fentanyl induced cough (Fentanylinduced cough, FIC) during induction of general anesthesia can greatly increase the risk of induction. There are many clinical methods and drugs that can inhibit FIC, but they are not ideal. The clinical antitussive drug, promethazine, can inhibit FIC. This experiment is to observe intravenous injection. The effect of promethazine hydrochloride, a small dose of antihistamine, on FIC, in order to find a new method of inhibiting FIC, in order to reduce or avoid the changes in the plasma histamine concentration after injection of fentanyl during induction of general anesthesia induction during induction of general anesthesia and the effect of preinjection of Promethazine on the concentration of histamine after fentanyl, and to explore the role of histamine in the occurrence of FIC. And whether promethazine can play a role in inhibiting histamine release.
Methods: in the first part, 200 patients undergoing elective surgery under general anesthesia were randomly divided into 4 groups before operation: control group and experimental group 1,2,3. Before anesthesia induction, 4 kinds of 0.1ml/kg solution were given to each group: 0.9%NS, 0.5mg/ml promethazine, 1mg/ml isopromethazine and 1.5mg/ml isopromethazine. All patients were induced by anesthesia induction. At the speed of 50 mu g/s, fentanyl was injected 3 u g/kg, 2min was given 1-1.5mg/kg, CIS atracurium 0.2mg/kg. inhaled 1-1.5MAC sevoflurane, intravenous infusion of remifentanil 0.1-0.2 u g/kg/min, CIS atracurium 0.3mg/kg/h maintenance anesthesia and muscle relaxation. The occurrence of coughing in patients with fentanyl 2min was recorded, including coughing. Interval, times, intensity, recording pre injection of promethazine (T0), intravenous injection of fentanyl (T1), pretracheal intubation (T3), blood pressure and heart rate after endotracheal intubation (T4), the time after operation to remove tracheal catheter and postoperative nausea and vomiting. Second part: select the 2 promethazine agent in the experimental group according to the results of the first part of the experiment. 30 cases of gallstone cholecystitis were randomly divided into two groups, the fentanyl group (group F) and the promethazine + fentanyl group (group FP): 3 mu g/kg fentanyl and 0.1ml/kg isopromethazine (1mg/ml) +3 mu g/kg fentanyl respectively, the anesthesia method was the same before. Before administration (T0), after the administration, the tracheal intubation 2min (T2) 2ml was measured in peripheral venous blood and plasma histamine concentration was measured.
Results: the first part: (1) general information of 4 groups of patients: age, sex, weight, height, disease and subjects were not significantly different (P0.05).
(2) the change of blood pressure and heart rate in the 4 groups: there was no significant difference in systolic pressure, diastolic pressure and heart rate in T0, T1, T2 and T3 (P0.05), T4 time point control group, experiment 2 group, and the 3 groups were significantly higher than the experimental group 1, the difference was statistically significant (P0.05), the rate of heart rate in the 3 groups was higher than that of the control group and the experimental 1,2 group, the difference was statistically significant P0.05. In group comparison, the rate of dessert, systolic pressure and diastolic pressure were significantly lower than that of T0, T1, T2 and T4 (P0.05), but there was no significant difference in the heart rate, systolic pressure and diastolic pressure in T0, T1, T2 and T4 (P0.05) in each group (T3).
(3) the incidence of FIC in the 4 groups: 16 cases of FIC in the control group (32%), with light, medium and severe 11,3,2 respectively. 8 cases (16%) occurred in the 1 group of FIC, of which the light, middle and severe cases were 4,2,2 respectively. The 2 groups were 6 (12%) in the experiment, of which the mild, middle and severe cases were respectively 1,2,3 cases. The experimental group of FIC occurred in 5 cases (10%), of which the light, medium, and severe cases were 2,0,3 cases respectively. The 1 groups, 2 groups, 3 groups of total coughing compared with the control group decreased significantly compared with the control group, the difference was statistically significant (P0.05); the mild FIC incidence of experimental 1, 2 groups, 3 groups were significantly lower than the control group, the difference was statistically significant (P0.05); the incidence of moderate and severe incidence of FIC was not statistically significant (P0.05). Group comparison: control group: control group: comparison group: control group: control group The mild incidence of internal FIC was significantly higher than the moderate and severe incidence, the difference was statistically significant (P0.05). There was no significant difference between moderate and severe (P0.05). There was no significant difference between the 1 groups in the experimental group, the 2 groups, and the moderate and severe incidence in the 3 groups (P0.05).
(4) the average time of occurrence of FIC in the 4 groups was 12.60s, 12.89s, 13.36s and 12.25s respectively, and there was no significant difference between the 4 groups (P0.05).
(5) the time of 4 groups of patients awakened and extubation: the control group, the experiment 1 groups, the 2 groups, the 3 groups of patients to stop all the anesthetic to the recovery of the tracheal tube time were 7.40 + 1.80min, 7.52 + 1.81min, 7.44 + 1.89min, 7.32 + 2.11min, four groups of patients to wake up the extraction of tracheal catheter time difference was not statistically significant (P0.05).
(6) postoperative nausea and vomiting, cough and phlegm: control group, experimental 1 groups, 2 groups, 3 groups, 1,1,1 and 2 cases; postoperative expectoration: control group, 1 groups, 2 groups, 3 groups of patients with postoperative nausea and vomiting, cough, cough and sputum incidence of no significant difference (P0.05). Second: Second: Second: (1) The general data of the two groups were not statistically different (P0.05). (2) the concentration of histamine in the venous plasma of the fentanyl group (group F) was 8.53 + 2.04ng/ml, 7.24 + 2.14ng/ml, 7.57 + 1.83ng/ml, and the concentration of histamine in the venous plasma of promethazine + fentanyl group (group FP) was 8.23 + 2.58ng/ml, 7.33 + and 7.23 + 2.02ng/ml, in and between the two groups and groups. There was no significant difference in the comparison (P0.05).
Conclusion: (1) pre injection of 0.05mg/kg, 0.1mg/kg, 0.15mg/kg promethazine hydrochloride can reduce the incidence of FIC,.3 dose has a slight effect on the blood pressure during the induction of anesthesia, and the time of the tracheal catheter removal after the operation, and the postoperative complications have no obvious effect.
(2) the change of plasma histamine concentration was not affected by the velocity injection of 50 mu g/s at the concentration of 50 mu g/ml fentanyl 3 u g/kg, and there was no significant effect on the change of plasma histamine concentration after injection of promethazine after injection of fentanyl.
【学位授予单位】：泸州医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614
【参考文献】
相关期刊论文 前3条
1 张罗,韩德民,顾之燕;抗组胺药物 H1 受体拮抗剂的临床药理学(一):组胺、组胺受体和抗组胺药物[J];中国耳鼻咽喉头颈外科;2005年01期
2 张瑞冬;陈锡明;陈煜;;芬太尼诱发呛咳的机制、影响因素和预防[J];国际麻醉学与复苏杂志;2006年06期
3 王艳;努尔尼沙·阿布都热合曼;;抗组胺药物的合理应用[J];临床合理用药杂志;2013年11期
本文编号：2135474
本文链接：https://www.wllwen.com/yixuelunwen/mazuiyixuelunwen/2135474.html
最近更新
教材专著
