预处理右美托咪定预防芬太尼诱发咳嗽的最佳剂量：一项前瞻性随机对照试验。
Optimal dose of pretreated-dexmedetomidine in fentanyl-induced cough suppression: a prospective randomized controlled trial.
机构信息
School of Medicine, Yangzhou University, Yangzhou, 225009, China.
Department of Anesthesiology, The Affiliated Hospital of Yangzhou University, Yangzhou, 225012, China.
出版信息
BMC Anesthesiol. 2019 Jun 1;19(1):89. doi: 10.1186/s12871-019-0765-z.
BACKGROUND
To investigate the optimal dose of pretreated-dexmedetomidine in fentanyl-induced cough (FIC) suppression.
METHODS
Patients of 180 undergoing elective surgery with general anesthesia, aged 18-65 years, BMI 18.5-30 kg/m, ASA I or II, were equally randomized into four groups (n = 45) to receive intravenous pretreatment of dexmedetomidine with 0 (group 1), 0.3 (group 2), 0.6 (group 3) and 0.9 (group 4) mcg/kg over 10 mins, respectively. After the pretreatment, all patients were given a 5-s intravenous injection of fentanyl 4 mcg/kg. The symptoms of irritating cough including the severity and onset time were recorded for 1 min after fentanyl injection. General anesthesia induction was completed with midazolam, propofol and cisatracurium, then endotracheal tube or laryngeal mask was inserted and connected to an anesthesia machine. MAP, HR and SpO at the beginning of pretreatment (T0), 3 min (T1), 6 min (T2), 9 min (T3) and 12 min (T4) after the beginning of pretreatment were recorded. Side effects of dexmedetomidine, such as bradycardia, hypertension, hypotension, and respiratory depression were also recorded during the course.
RESULTS
Totally 168 patients completed the study. The incidences of cough were 52.4, 42.9, 11.9, and 14.3% in groups 1, 2, 3, and 4, respectively, with no significant differences between groups 1 and 2 (P > 0.05) and between groups 3 and 4 (P > 0.05). The incidence and severity of cough in groups 3 and 4 were significantly lower than those in groups 1 and 2 (P < 0.05). Compared to T0, HR at T2 (P < 0.05), T3 (P < 0.01), and T4 (P < 0.01) decreased significantly and MAP at T4 decreased significantly (P < 0.05) in group 4. Bradycardia occurred in 1 case and respiratory depression occurred in 1 case in group 4. Compared to group 1, the onset time of cough in the other 3 groups were delayed significantly (P < 0.05).
CONCLUSION
Pretreated dexmedetomidine 0.6 mcg/kg blous intravenous infusion over 10 mins could reduce FIC effectively without side effects.
TRIAL REGISTRATION
This study was registered in ClinicalTrials.gov (NCT03126422), April 13, 2017.
背景
研究预先给予右美托咪定的不同剂量对芬太尼诱发咳嗽（FIC）的抑制作用。
方法
选择择期全麻手术患者 180 例，年龄 18-65 岁，BMI 18.5-30kg/m，ASA Ⅰ或Ⅱ级，随机均分为 4 组（每组 45 例），分别于预注前 10min 静脉给予右美托咪定 0（组 1）、0.3（组 2）、0.6（组 3）和 0.9μg/kg（组 4）。预注后 5s 静脉注射芬太尼 4μg/kg。记录芬太尼注射后 1min 内刺激性咳嗽的症状，包括严重程度和发作时间。全麻诱导采用咪达唑仑、丙泊酚和顺式阿曲库铵，然后插入气管内导管或喉罩，并与麻醉机相连。记录预注前（T0）、预注后 3min（T1）、6min（T2）、9min（T3）和 12min（T4）时的 MAP、HR 和 SpO。记录右美托咪定的不良反应，如心动过缓、高血压、低血压和呼吸抑制等。
结果
共有 168 例患者完成了研究。组 1、2、3 和 4 的咳嗽发生率分别为 52.4%、42.9%、11.9%和 14.3%，组 1 和 2（P>0.05）以及组 3 和 4（P>0.05）之间无显著差异。组 3 和 4 的咳嗽发生率和严重程度明显低于组 1 和 2（P<0.05）。与 T0 相比，组 4 在 T2（P<0.05）、T3（P<0.01）和 T4（P<0.01）时 HR 明显降低，T4 时 MAP 明显降低（P<0.05）。组 4 发生 1 例心动过缓，1 例呼吸抑制。与组 1 相比，其余 3 组的咳嗽发作时间明显延迟（P<0.05）。
结论
预先给予右美托咪定 0.6μg/kg 静脉输注 10min 可有效抑制 FIC，且无不良反应。
试验注册
本研究于 2017 年 4 月 13 日在 ClinicalTrials.gov（NCT03126422）注册。
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