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A small dose of remifentanil pretreatment suppresses sufentanil-induced cough during general anesthesia induction: a randomized, double-blind, placebo-controlled trial
背景与目的
静脉注射舒芬太尼可引起咳嗽。本研究旨在评价小剂量瑞芬太尼预处理对舒芬太尼在全面诱导期间引起的咳嗽的抑制作用。
方 法
这一前瞻性随机对照试验于1月10日至3月1日进行。共有100名病人在全麻下接受择期手术，最后纳入84例患者并将其随机分为两组(n=42)：瑞芬太尼组(R组)在舒芬太尼注射前1 min静脉注射瑞芬太尼0.3μg/kg(稀释至2ml)，对照组(C组)同时给予2ml生理盐水(N）。两组患者在5s内完成注射。然后，在5s内注射舒芬太尼0.5μg/kg，并记录舒芬太尼注射后1分钟内发生的咳嗽次数。舒芬太尼注射后1分钟，无论有无咳嗽发生，均使用依托咪酯0.3mg/kg和顺式阿曲库铵0.15 mg/kg全麻诱导。分别记录瑞芬太尼预处理给药前（T0）、给药后3分钟（T1）、插管后1分钟（T2）和插管后3分钟（T3）几个时点的平均动脉压（MAP）和心率（HR）。
结 果
R组和C组患者咳嗽发生率分别为4.8%和31%。与C组相比，R组咳嗽的发生率和严重程度明显降低（P<0.01）。全麻诱导时MAP、HR两组比较无显着性差异(P>0.05)。
结 论
小剂量瑞芬太尼预处理可有效、安全地降低舒芬太尼麻醉诱导期咳嗽的发生率和严重程度，且可作为一种替代方法治疗舒芬太尼引起的咳嗽。
原始文献摘要
Wendong Lin, Jiehao Sun，and Shuying Fu.A small dose of remifentanil pretreatment suppresses sufentanil-induced cough during general anesthesia induction: a randomized, double-blind, placebocontrolled trial.Anesthesiology()19:164,3-6.
Background: Intravenous use of sufentanil can elicit cough. This study aimed to evaluate the inhibitory effect of pre-injection of a mall dose of remifentanil on sufentanil-induced cough during the induction of general anesthesia.
Methods: This prospective, randomized, controlled trial was conducted from January 10, to March 01, . A total of 100 patients undergoing elective surgery under general anesthesia were enrolled, and at last 84 patients were included and randomly allocated into two equal size groups (n = 42): Patients in the Remifentanil group (R group) received an intravenous infusion of remifentanil 0.3 μg/kg (diluted to 2 ml) 1 min before sufentanil injection; patients in the Control group (C group) received 2 ml of normal saline (NS) at the same time point. Injections of patients in both groups were completed within 5 s. Then, sufentanil 0.5 μg/kg was injected within 5 s and the number of coughs that occurred within 1 min after sufentanil injection were recorded. One minute after sufentanil injection, etomidate 0.3 mg/kg and cisatracurium 0.15 mg/kg were given for general anesthesia induction irrespective of the presence or absence of cough. The mean arterial pressure (MAP) and heart rate (HR) at time points just before remifentanil pretreatment administration (T0), 3 min after administration (T1), 1 min after intubation (T2), and 3 min after intubation (T3) were recorded.
Results: The incidence of cough in patients in the R group and C group was 4.8 and 31%, respectively. Compared with group C, the incidence and severity of cough in group R was significantly lower (P < 0.01). No significant differences were observed in MAP and HR at the time of general anesthesia induction between the two groups (P > 0.05).
Conclusion: Pretreatment with a small dose of remifentanil effectively and safely reduced the incidence and severity of cough induced by sufentanil during anesthesia induction and can be used as an alternative treatment to inhibit coughing caused by sufentanil.
贵州医科大学高鸿教授课题组
翻译：任文鑫 编辑：何幼芹 审校：王贵龙
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