不同效应室靶浓度丙泊酚靶控输注对舒芬太尼呛咳反应的影响

摘要

Objective To observe the effects of different propofol target concentrations infusion on preventing sulfentanil-induced cough during general anesthesia induction. Methods Four hundred patients were randomly as-signed to receive propofol target effect-site concentration of 0 (group P0), 2.0μg/mL (group P1), 3.0μg/mL (group P2), 4.0μg/mL (group P3) from February to December in 2014. When the propofol effect-site concentration reached the tar-get, all the patients were injected with sulfentanil (0.4μg/kg) through peripheral venous within 5 seconds. The occur-rence, time and severity of cough was recorded within one minute after sulfentanil injection, and the changes of blood pressure and heart rate were observed. Results Compared with group P0 or P1, the overall incidence of cough signifi-cantly decreased in group P3 (P<0.05). The incidence of severe cough in group P3 was significantly lower than that in group P0 and P2 (P<0.05). Compared with group P0 or P1, the overall incidence of cough in group P2 significantly de-creased (P<0.05). The overall incidence of cough shows no statistically significant differences between group P1 and group P2 (P>0.05). Compared to group P0, the MAP and HR of the other groups were significantly lower after TCI (P<0.05). Conclusion A propofol target effect-site concentration of 3.0μg/mL or 4.0μg/mL can both effectively suppress sulfentanil-induced cough, but concentration of 4.0μg/mL has the better effect.%目的：评价全身麻醉诱导期间使用不同效应室靶浓度对舒芬太尼诱发呛咳反应的影响。方法选择2014年2~12月400例ASAⅠ~Ⅱ级的择期手术患者，采用随机数表法分为四组，即P0、P1、P2、P3组，每组各100例。在全麻诱导前分别接受0、2.0μg/mL、3.0μg/mL、4.0μg/mL效应室浓度的丙泊酚进行靶控输注，当效应室浓度达到靶浓度后，均由左上肢静脉给予0.4μg/kg舒芬太尼(5 s内快速注入)，观察给药后1 min内呛咳反应发生率、呛咳情况及血流动力学变化。结果与P0组及P1组比较，P3组患者的呛咳程度较轻，差异有统计学意义(P<0.05)；P2组与P0组比较，P2组呛咳程度较轻，差异有统计学意义(P<0.05)；P0组与P1组比较差异无统计学意义(P>0.05)。P0、P1、P2、P3组呛咳发生时间分别为(18.2±5.6) s、(18.3±5.2) s、(18.9±4.9) s、(18.8±5.1) s，组间比较差异无统计学意义(P>0.05)。与P0组比较，P1组、P2组及P3组在靶控输注不同剂量丙泊酚后，平均动脉压(MAP)及心率(HR)下降明显(P<0.05)，而各组各时间点的血氧饱和度(SpO2)比较差异无统计学意义(P>0.05)。结论3.0μg/mL及4.0μg/mL效应室靶浓度的丙泊酚均能有效抑制舒芬太尼诱发的呛咳反应，但4.0μg/mL靶浓度的丙泊酚效果更佳。