倍他米松用于芬太尼靜脈誘導(dǎo)時(shí)咳嗽反射的臨床觀察

1、倍他米松用于芬太尼靜脈誘導(dǎo)時(shí)咳嗽反射的臨床觀察         11-02-14 13:23:00     作者：文生豪 田毅 周朝    編輯：studa20【摘要】  目的：觀察倍他米松預(yù)防芬太尼靜脈誘導(dǎo)時(shí)咳嗽反射的效果。方法：100例擇期全麻手術(shù)患者分為倍他米松組(10 mg靜脈注射)和對(duì)照組(等量生理鹽水靜脈注射)。均在右上肢遠(yuǎn)端建立外周靜脈通道，給藥后10 min開(kāi)始靜脈誘導(dǎo)，兩組芬太尼6 g/kg均在15 s內(nèi)勻速

2、注入。觀察指標(biāo)：(1)各組患者從開(kāi)始注射芬太尼至給藥后2 min內(nèi)出現(xiàn)咳嗽的例數(shù)和強(qiáng)度變化;(2)觀察各組麻醉前、給芬太尼后2 min、給全麻藥完后1 min、氣管插管后即刻、氣管插管后5 min時(shí)的HR、MAP、SpO2的變化。結(jié)果:倍他米松組咳嗽發(fā)生率為8.3%，與對(duì)照組(35%)相比有顯著性差異。對(duì)照組輕、中、重度咳嗽發(fā)生率與倍他米松組各咳嗽強(qiáng)度組相比均有顯著性差異。T1時(shí)段兩組的HR、MAP相比有顯著性差異。組內(nèi)發(fā)生咳嗽反射患者與沒(méi)出現(xiàn)咳嗽反射的患者相比HR、MAP明顯升高， 值也有所回升。結(jié)論： 預(yù)先靜脈注射倍他米松可有效降低麻醉誘導(dǎo)期間芬太尼所致咳嗽反射的發(fā)生。 【關(guān)鍵詞】

3、0; 倍他米松;芬太尼;咳嗽反射;麻醉，全身ABSTRACT Objective: To observe the effect of betamethasone on preventing cough reflex induced by intravenous injection of fentanyl. Methods: 100 cases of selective anesthesia patients were divided into betamethasone group (10 mg iv) and control group (10 mg saline iv).Venous ac

4、cess was set up in the right upper distal limb, intravenous induction was started 10 min latter after administration, fentanyl was injected in 15 s at 6 g/kg. The number of cough cases and intensity change of patients were observed in 2 min after injection of fentanyl,and the changes of HR, MAP, SpO

5、2 in the following time points were recorded：before anesthesia,2 min after fentanyl injection,1 min after all anesthetics injection,right after intubation, 5 min after tracheal intubation. Results: The incidence of cough was 8.3% in betamethasone group,there was significant difference compared with

6、the control group (35%). There was significant difference in the incidence of mild, moderate, severe cough in control group compared with betamethasone group. There was significant difference in HR, MAP of two groups at T1 time. HR, MAP increased significantly in patients with cough reflex than no c

7、ough reflex, the value rised too. Conclusion: Injection of betamethasone in advance could effectively reduce cough reflex caused by fentanyl induction.KEY WORDS Betamethasone; Fentanyl; Cough reflex; Anesthesia, general芬太尼是臨床上最常用的阿片類鎮(zhèn)痛劑,除能夠達(dá)到滿意的鎮(zhèn)痛效果外 ,還可以有效地降低誘導(dǎo)及氣管插管期間的應(yīng)激反應(yīng)1,但靜脈注射芬太尼后患者常發(fā)生激烈的咳嗽反射及胸壁

8、肌肉強(qiáng)直等不良反應(yīng)。如何預(yù)防芬太尼誘發(fā)的咳嗽反射，對(duì)提高患者麻醉安全具有重要意義。本研究旨在觀察倍他米松對(duì)咳嗽反射的影響。芬太尼是臨床上最常用的阿片類鎮(zhèn)痛劑,除能夠達(dá)到滿意的鎮(zhèn)痛效果外 ,還可以有效地降低誘導(dǎo)及氣管插管期間的應(yīng)激反應(yīng),但靜脈注射芬太尼后患者常發(fā)生激烈的咳嗽反射及胸壁肌肉強(qiáng)直等不良反應(yīng)。如何預(yù)防芬太尼誘發(fā)的咳嗽反射，對(duì)提高患者麻醉安全具有重要意義。本研究旨在觀察倍他米松對(duì)咳嗽反射的影響。1 資料與方法1.1 臨床資料120例擇期全麻手術(shù)患者(ASA 12級(jí))，男性66例，女性54例，年齡2070歲，體重4585 kg?；颊咝呐K功能正常，無(wú)感冒、咳嗽、哮喘及其他呼吸系統(tǒng)并發(fā)癥，手術(shù)

9、前戒煙超過(guò) 8 周并且術(shù)前2周內(nèi)未使用血管緊張素轉(zhuǎn)換酶抑制劑、支氣管擴(kuò)張劑和類固醇激素等藥物?；颊吒鶕?jù)計(jì)算機(jī)隨機(jī)數(shù)字表隨機(jī)進(jìn)入兩組，倍他米松組(I組)60例，對(duì)照組(II組)60例。兩組患者的性別、年齡、體重等一般資料經(jīng)檢驗(yàn)差異均無(wú)統(tǒng)計(jì)學(xué)意義，具有可比性。1.2 麻醉方法患者術(shù)前30 min肌內(nèi)注射阿托品0.5 mg，魯米鈉0.1 g。入手術(shù)室后均在右上肢遠(yuǎn)端建立外周靜脈通道，并監(jiān)測(cè)心電圖、有創(chuàng)動(dòng)脈血壓(MAP)，脈搏氧飽和度(SpO2)。I組靜脈注射倍他米松10 mg;II組則靜脈注射等量生理鹽水，均在10 min后開(kāi)始行靜脈誘導(dǎo)。通過(guò)外周靜脈依次給以咪達(dá)唑侖0.1 mg/kg，芬太尼6 g

10、/kg、依托咪酯0.3 mg/kg、維庫(kù)溴銨0.1 mg/kg。兩組芬太尼的注藥速度均為15 s內(nèi)勻速注入。1.3 觀察指標(biāo)(1)各組患者從開(kāi)始注射芬太尼至給藥后2 min內(nèi)出現(xiàn)咳嗽的例數(shù)和強(qiáng)度變化。患者出現(xiàn)咳嗽的嚴(yán)重程度根據(jù)咳嗽頻率強(qiáng)度進(jìn)行評(píng)分，評(píng)分標(biāo)準(zhǔn)為：無(wú)咳嗽：0 次 ;輕度咳嗽：12 次 ;中度咳嗽：34 次 ;重度咳嗽：5 或>5 次2。(2)觀察各組麻醉前(T0) 、給芬太尼后2 min(T1) 、給全麻藥完后1 min(T2) 、氣管插管后即刻(T4)、氣管插管后5 min(T5)時(shí)的心率(HR)、MAP、SpO2的變化。1.4 統(tǒng)計(jì)學(xué)處理計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差(±s)表示，采用單因素方差分析及q檢驗(yàn)進(jìn)行比較。計(jì)數(shù)資料采