瞬时推注地佐辛和芬太尼混合液预防芬太尼呛咳反应ED50的测定

摘要

目的 探讨麻醉诱导前快速推注地佐辛和芬太尼混合液预防芬太尼呛咳反应的有效性及其半数有效量(ED50).方法 选择拟行择期全身麻醉手术女性患者31例,年龄24 ～ 49岁,ASA Ⅰ～Ⅱ级,依据Dixon序贯法,第1例患者在麻醉诱导前2s内快速推注剂量为0.050 mg/kg的地佐辛和6μg/kg的芬太尼混合液,观察2 min,如果该患者出现呛咳反应,则下一例患者地佐辛剂量成比例增加1.2倍,直至呛咳反应被抑制,反之则减少1.2倍,直至患者出现呛咳反应,同时监测患者入室时(T1)、快速推注地佐辛和芬太尼混合液后2 min (T2)的心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO2),根据Dixon序贯法计算地佐辛混合液预防芬太尼呛咳反应ED50.结果 不同剂量地佐辛和芬太尼混合液预防芬太尼呛咳反应中出现呛咳反射的患者数分别为:0.012 mg/kg 3例,0.014 mg/kg 7例,0.017 mg/kg 3例,0.020 mg/kg及以上时所有患者均未见呛咳反应.依据Dixon序贯法计算地佐辛和芬太尼混合液预防芬太尼呛咳反应的ED50为0.018 mg/kg(95％CI:0.017 ～0.019),呛咳反射组患者芬太尼诱导后HR明显升高(P＜0.05),其余组内、组间的测量值差异均未见统计学意义.结论 瞬时推注小剂量地佐辛和芬太尼混合液能够预防芬太尼呛咳反应,其ED50为0.018 mg/kg(95％CI:0.017～0.019).%Objective To investigate the efficacy and the median effective dose(ED50) of rapid infusion of dezocine and fentanyl for preventing fentanyl-induced coughing during induction of anesthesia.Methods Thirty-one patients aged from 24 to 49 years,ASA Ⅰ-Ⅱ,undergoing elective surgery through general anesthesia were enrolled.According to Dixon's up-and-down method,the first patient was injected with 0.050 mg/kg dezocine and 6 μg/kg fentanyl before induction of anesthesia within 2 seconds,if the patient had a cough reflex within 2 minute,the next patients would receive 1.2 times dose of previous dezocine until the cough reflex was suppressed,or otherwise reduce 1.2 times dose of previous dezocine until the patients appeared cough reflex.The time after the patients enter the operating room (T1),after mixture of dezocine and fentanyl injected 2 minutes (T2),the HR,MAP and SpO2 were monitored and recorded.Results The numbers of patients with different doses appeared cough reflex when mixtures of dezocine for preventing fentanyl cough reflex:0.012 mg/kg for 3 patients,0.014 mg/kg for 7 patients,0.017 mg/kg for 3 patients,and 0.020 mg/kg and above for nobody.The EDS0 of the dezocine for preventing fentanyl-induced coughing was 0.018 mg/kg (95％ CI:0.017-0.019) with Dixon's up-anddown method.After quickly injecting mixture 2 minutes,only the HR significantly increased in the cough group (P ＜ 0.05),and there were no significant differences between and within groups.Conclusions Instant injection mixture of dezocine and fentanyl could prevent fentanyl-induced coughing and ED50 is 0.018 mg/kg (95％ CI:0.017-0.019).