盐酸戊乙奎醚联合深呼吸法抑制麻醉诱导时芬太尼诱发咳嗽反应的有效性和安全性

Efficacy and safety of Penehyclidine hydrochloride combined with huffing manoeuvre in suppressing Fentanyl-induced cough response during anesthesia induction

摘要:

目的探讨盐酸戊乙奎醚（PHC）联合深呼吸法抑制麻醉诱导时芬太尼诱发的咳嗽反应（FIC）的有效性和安全性。方法选取2015 年9 月-2016 年9 月该院行手术治疗的220 例患者的临床资料，随机分为4 组，每组55例。H组：于静脉注射芬太尼前10 min给予PHC 0.01 mg/kg，用生理盐水稀释成10 ml静脉注射。P组：芬太尼静脉注射前，患者完成3 次深呼吸后立刻静脉注射芬太尼。M 组：静脉推注芬太尼前10 min给予PHC0.01 mg/kg用生理盐水稀释成10 ml 静脉注射，完成3 次深呼吸后立即给予患者静脉注射芬太尼。N 组：按照一定诱导顺序给予静脉快速诱导。记录患者静脉注射芬太尼后2 min 内咳嗽出现的时间及严重程度，并计算咳嗽发生率；记录静脉注射芬太尼前10 min 或静脉注射PHC（T0）、静注芬太尼后1 min（T1）、2 min（T2）的心率（HR）、收缩压（SBP）、舒张压（DBP）和脉搏血氧饱和度（SpO2）；并分别计算平均动脉压（MAP）。结果4组患者咳嗽程度比较差异有统计学意义（χ2=153.424，p =0.001）；4组咳嗽发生时间比较差异有统计学意义（χ2 =26.509，p=0.019）。4 组患者FIC发生率差异有统计学意义（χ2=12.488， p=0.006）。H 组、P 组、M组和N组FIC 发生率分别为8 例（14.5%）、7 例（12.7%）、4 例（7.3%）和17 例（30.9%），将H 组、P 组和M 组合并后，并与N 组比较，差异有统计学意义（χ2=11.337，p =0.001）；4 组患者HR、SpO2及MAP 在T0、T1和T2时逐渐降低；T2时HR和MAP 比T0时降低，差异有统计学意义（p <0.05），T0、T1 和T2 时间的SpO2差异无统计学意义（p >0.05）。4 组不良反应发生率及不良反应比较无统计学意义（p >0.05）。结论PHC 联合深呼吸法能有效抑制FIC 的发生，优 于单独使用PHC 和深呼吸法，且对患者血流动力学影响小，不良反应少，安全性高。

Abstract:

Objective To investigate the efficacy and safety of Penehyclidine hydrochloride (PHC) combined with huffing manoeuvre in suppressing Fentanyl induced cough response (FIC) during anesthesia induction. Methods The clinical data of 220 patients who underwent surgical treatment from September 2015 to September 2016 in our hospital were randomly divided into 4 groups (55 in each). In group H, the patients recived PHC 0.01 mg/kg diluted with normal saline into 10 ml intravenous injection before 10 ml intravenous injection. In group P, the patients were given intravenous fentanyl immediately after three deep breaths. In group M, the patients receiving PHC 0.01 mg/kg diluted with normal saline into 10 ml intravenous injection before 10 min were given intravenous fentanyl immediately after three deep breaths. In group N, the patients were given intravenous rapid induction according to a certain induction order. The occurrence time and severity of coughing were recorded within 2 min after intravenous injection of Fentanyl, and the incidence of cough was calculated. The heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse oxygen saturation (SpO2) were measured 10 min before intravenous injection of Fentanyl or intravenous injection of Penehyclidine hydrochloride (T0), and 1 (T1) and 2 min (T2) after intravenous injection of Fentanyl; and the mean arterial pressure (MAP) was calculated. Results There were statistically significant differences in the degree of cough among the four groups (x2 = 153.424, p= 0.001). There were significant differences in cough occurrence time among the four groups ( x2= 26.509, p= 0.019). There were statistically significant differences in FIC incidence among the four groups (x2 = 12.488, p= 0.006). The incidence of FIC in the H group, the P group, the M group and the N group was 14.5% (8 cases), 12.7% (7 cases), 7.3% (4 cases) and 30.9% (17 cases) respectively. After merging the H group, the P group and the M group, and then compared with the N group, the difference was statistically significant (x2 = 11.337, p= 0.001). In the four groups, HR,SpO2 and MAP decreased gradually at T0, T1 and T2; HR and MAP at T2 were lower than those at T0, the differences were statistically significant (p < 0.05), the SpO2 at T0, T1 and T2 was not significantly different (p >0.05). There were no significant differences in the adverse reactions among the four groups (p > 0.05). Conclusions PHC combined with deep breathing method can effectively inhibit the occurrence of FIC, and is superior to either of PHC and deep breath, also has little impact on patients' hemodynamics with few adverse reactions and high safety.