摘要:
目的：观察预注纳美芬能否有效抑制芬太尼诱发的呛咳反应，以及预注纳美芬对患者诱导期间血流动力学的影响。方法：纳入择期全麻手术患者78例，美国麻醉医师协会（ASA）Ⅰ或Ⅱ级，随机分成3组，每组26例。3组患者入室后100%O2面罩通气2 min（T0），静脉诱导前分别注射0.9%氯化钠液（对照组）、0.25 μg/kg纳美芬（0.25纳美芬组）、0.5 μg/kg纳美芬（0.5纳美芬组）10 mL，2 min后（T1）记录心率（HR）、无创血压（NBP）、脉搏氧饱和度（SpO2）；5 s内静脉注射4 μg/kg芬太尼，2 min后（T2）记录HR、NBP、SpO2，并观察这2 min内是否出现呛咳反应。T2时刻后静脉注射2.5 mg/kg丙泊酚、0.6 mg/kg罗库溴铵、1.5 mg/kg利多卡因诱导，90 s后行气管插管。气管插管后（T3）即刻记录HR、NBP、SpO2。结果：对照组呛咳的发生率为53.8%，高于0.25纳美芬组（3.8%，P<0.01）及0.5纳美芬组（0，P<0.01）。纳美芬组与对照组各时间点血流动力学差异均无统计学意义。结论：预注纳美芬能有效抑制芬太尼诱导时的呛咳反应，且在试验剂量下不影响阿片类药物的交感抑制作用，不影响患者血流动力学。
关键词:
-
纳美芬
/
-
芬太尼
/
-
呛咳
/
-
血流动力学
Abstract:
Objective：To evaluate the suppressive effects of nalmefene pretreatment on the incidence of fentanyl-induced cough (FIC), and to observe the influence of nalmefene pretreatment on hemodynamic stability during general anesthesia induction. Methods：A total of 78 patients of American Society of Anesthesiologists(ASA)Ⅰand Ⅱ were enrolled and randomly divided into 3 groups (26 patients in each group). Patients in the 3 groups were ventilated by face mask 2 min (T0) after entering the operating room. Patients in the control group,nalmefene 0.25 group, nalmefene 0.5 group received normal saline, 0.25 μg/kg nalmefene,or 0.5 μg/kg nalmefene 10 mL before anesthesia induction respectively,2 min later(T1), the heart rate (HR), noninvasive blood pressure (NBP), and pulse oxygen saturation(SpO2) were recorded. Patients were then administrated with 4 μg/kg fentanyl within 5 s. The incidence of FIC and the vital signs were recorded 2 min after administration of fentanyl bolus (T2). After T2, patients were administered with 2.5 mg/kg propofol, 0.6 mg/kg rocuronium, and 1.5 mg/kg lidocaine, 90 s later, the intubation was performed (T3). The vital signs were also recorded after T3. Results：The incidence of cough in the control group was 53.8%, much higher than that in the nalmefene 0.25 group (3.8%,P<0.01) and nalmefene 0.5 group(0%, P<0.01). There was no significant difference in the hemodynamics between the control group and the nalmefene groups in the corresponding time points. Conclusions：Pretreatment of nalmefene could effectively suppress the FIC during general anesthesia induction, and it might not reverse the effect of opioids on sympathetic response and influencethe hemodynamic stability.
下载:
