王茂华　张静　赵梦雅

[摘要] 目的 探討不同浓度芬太尼对诱发呛咳时间与发生率的影响。 方法 选择2017年1～11月在扬州大学附属医院择期进行全麻手术的患者300例，采用随机数字表法将患者分为6组，未稀释对照A组（A1组）；稀释1倍A组（A2组）：将芬太尼与生理盐水1︰1稀释；稀释2倍A组（A3组）：将芬太尼与生理盐水1︰2稀释，后3组均以5 s时间匀速注射；未稀释对照B组（B1组）；稀释1倍B组（B2组）：将芬太尼与生理盐水1︰1稀释；稀释2倍B组（B3组），将芬太尼与生理盐水1︰2稀释，后3组均以10 s时间匀速注射，每组各50例。记录比较各组患者出现呛咳反应的时间以及呛咳反应发生率。 结果 相同给药浓度，不同给药速度时，B1组出现呛咳时间比A1组明显延长（P < 0.05）；B1组呛咳发生率低于A1组（P < 0.05）；B2组出现呛咳时间比A2组明显延长，差异有统计学意义（P < 0.05）；B2组呛咳发生率低于A2组（P < 0.05）；B3组出现呛咳时间比A3组显著延长，差异有统计学意义（P < 0.05）。相同给药速度，不同给药浓度时，与A1组比较，A2组、A3组出现呛咳时间无明显变化，差异无统计学意义（P > 0.05）；A2组呛咳发生率低于A1组（P < 0.05）；且A3组呛咳发生率显著低于A1组和A2组，差异有统计学意义（P < 0.05）；与B1组比较，B2组出现呛咳反应时间无延长趋势（P > 0.05）；B2组呛咳发生率略低于B1组（P < 0.05）；B3组出现呛咳反应时间与B1组、B2组比较，有延长趋势（P < 0.05）；B3组呛咳发生率显著低于B1组和B2组，差异有统计学意义（P < 0.05）。 结论 降低芬太尼的给药速度和浓度，可延长出现呛咳反应的时间，降低其诱发呛咳反应发生率，将芬太尼与生理盐水1︰2稀释抑制呛咳反应效果显著，对提高患者麻醉安全具有重要意义。

[关键词] 芬太尼；给药浓度；呛咳；发生率

[中图分类号] R641.2 [文献标识码] A [文章编号] 1673-7210（2018）05（a）-0085-04

Effect of different concentrations of the incidence and onset time of rate of Fentanyl-induced cough

WANG Maohua ZHANG Jing ZHAO Mengya CHEN Maogui ZHANG Zhuan SUN Xiaohong SUN Jianhong

Department of Anesthesiology， the Affiliated Hospital of Yangzhou University， Jiangsu Province， Yangzhou 225000， China

[Abstract] Objective To investigate the effect of different concentrations of the incidence and onset time of rate of Fentanyl-induced cough. Methods From January to November 2017， 300 patients with general anesthesia for elective surgery in Affiliated Hospital of Yangzhou University were selected as research subjects. They were randomly divided into six groups using a random number table， non dilution control group A （group A1）. One times dilute group A （group A2）︰ Fentanyl and normal saline 1︰1 were diluted and was uniform； 2 times dilute group A （group A3）︰ Fentanyl and normal saline 1︰2 were diluted and was uniform， and those three groups were injected at 5 s， non dilution control group B （group B1）. One times dilute group B （group B2）︰ Fentanyl and normal saline 1︰1 were diluted and was uniform； 2 times dilute group B （group B3）︰ Fentanyl and normal saline 1︰2 were diluted and was uniform， and those three groups were injected at 10 s， with 50 cases in each group. The time of cough and the incidence rate of cough among the six groups were recorded and compared. Results When the concentration of the drug was the same and the speed of drug delivery was different， the cough onset time in group B1 were significantly longer than group A1 （P < 0.05）. The incidence of cough in group B1 were significantly lower than group A1 （P < 0.05）， the cough onset time in group B2 were significantly longer than group A2 （P < 0.05）. The incidence of cough in group B2 were significantly lower than group A2 （P < 0.05）， the cough onset time in group B3 were significantly longer than group A3 （P < 0.05）. When the speed of drug delivery was the same and the concentration of the drug was different， compared with group group A1， there was no statistically significant differences of cough onset time in group A2 and group A3 （P > 0.05）， the incidence of cough in group A2 were lower than group A1 （P < 0.05）， and the incidence of cough in group A3 were significantly lower than group A1 and group A2 （P < 0.05）. Compared with group group B1， there was no longer of the cough onset time in group B2 （P > 0.05）， and the incidence of cough in group B2 were lower than group B1， the differen （P < 0.05ce was statistically signifincant）. Compared with group B1 and group B2， the cough onset time in group B3 were significantly longer than group B1 and group B2， and the incidence of cough in group B3 were significantly lower than group B1 and group B2， the differences were statistically significant （P < 0.05）. Conclusion Reducing the speed of drug delivery and concentration of Fentanyl， which can prolonging the time of the cough onset time， reduce the incidence of cough， when the Fentanyl and normal saline 1︰2 were diluted and was uniform， which can significant inhibition of cough， thus it is significance to improve the safety of the patients′ anesthesia.

[Key words] Fentanyl； Injection concentration； Cough； Incidence rate

芬太尼是阿片类药物中较为常用的一种，理论上具有镇咳功效，但在临床实际应用过程中，特别是单次静脉注射给药时，有50%左右的患者会伴随出现呛咳反应[1]。芬太尼临床特点为较强应激反应抑制、快速起效，医生在全麻诱导的临床中最为常用。对于预防芬太尼药物引发的呛咳反应，目前有大量研究报道认为，通过减少药物给药剂量、控制药物给药速度以及给予利多卡因、地佐辛、麻黄碱、酸酸纳美芬、右旋美托咪啶等药物干预，能够实现对呛咳的预防[2-3]。但有关芬太尼的浓度对呛咳反应的影响，目前文献报道较少。本研究通过观察不同浓度的芬太尼引起呛咳反应的发生率和发生时间的影响，从而有效抑制芬太尼引起的呛咳反应，为临床医生如何使用芬太尼提供依据。……