对七氟醚作为一种辅助药物在基于丙泊酚的全静脉麻醉的非插管胸腔镜手术中有效减弱咳嗽反射的研究
2018/12/17
摘要
背景：非插管胸腔镜手术近年来得到了广泛的发展。咳嗽反射是接近肺部病灶时不可避免的问题，可能引起大出血。七氟醚麻醉可通过抑制肺刺激受体来减轻咳嗽反射。然而，吸入麻醉术后恶心呕吐(PONV)的发生率高于基于丙泊酚的全静脉麻醉(TIVA)。我们研究了七氟醚联合基于丙泊酚的全静脉麻醉(TIVA)对非插管胸腔镜手术中咳嗽反射和PONV的影响。
方法：随机选择90例喉罩气道(LMA)非插管胸腔镜手术和自主呼吸的患者进行TIVA或者异丙酚/七氟醚麻醉。TIVA组(n = 45)采用异丙酚、芬太尼麻醉诱导维持;丙泊酚/七氟醚(P/S)组(n = 45)采用丙泊酚/芬太尼麻醉加1%七氟醚麻醉。主要测量结果是咳嗽反射。此外，我们还研究了PONV的发生率和拔管时间。
结果：P/S组咳嗽反射患者明显少于TIVA组(10/45 vs 34/45;P <0.001)。咳嗽严重程度(35/5/5/0 vs 11/17/17/0;P <0 .001)和肢体运动(40/5/0/0 vs 28/17/0/0;P < 0.001) P/S组较TIVA组低。P/S组使用芬太尼止咳丸5个 (0 [0-1])，TIVA组使用芬太尼止咳丸17 个(0 [0-3])(P <0 .05)。两组患者均未发生转用全身麻醉、术后出血、吸入性肺炎或PONV的情况。此外,两组患者在拔管时间上没有显著差异(TIVA: 5.04±2.88 vs P / S: 4.44±2.98分钟;P =0 .33)。
结论：七氟醚联合基于丙泊酚的全静脉麻醉(TIVA)可减弱咳嗽反射，并且不会增加未插管胸腔镜手术PONV的发生率和拔管时间。
Sevoflurane is an effective adjuvant to propofol-based total intravenous anesthesia for attenuating cough reflex in nonintubated video-assisted thoracoscopic surgery.
Lai HC1, Huang TW2, Tseng WC1, Lin WL1, Chang H2, Wu ZF1.
Abstract
BACKGROUND: Nonintubated video-assisted thoracic surgery (VATS) has been widely developed during the recent years. Cough reflex is an inevitably encountered problem while approaching lung lesions, and it may induce major bleeding. Sevoflurane anesthesia may attenuate cough reflex by inhibiting the pulmonary irritant receptors. However, the incidence of postoperative nausea and vomiting (PONV) in inhalational anesthesia is higher than in the propofol-based total intravenous anesthesia (TIVA). We investigated the effect of sevoflurane combination with propofol-based TIVA on cough reflex and PONV in nonintubated VATS.
METHODS: Ninety patients undergoing nonintubated VATS with laryngeal mask airway (LMA) and spontaneous breathing were randomly assigned for TIVA or propofol/sevoflurane anesthesia. In the TIVA group (n = 45), anesthesia was induced and maintained with propofol and fentanyl; in the propofol/sevoflurane (P/S) group (n = 45), 1% sevoflurane anesthesia was added to propofol and fentanyl anesthesia. The primary outcome measurements were cough reflex. In addition, the incidence of PONV and extubation time were investigated.
RESULTS: Patients with cough reflex were significantly fewer in the P/S group than in the TIVA group (10/45 vs 34/45; P < .001). The cough severity (35/5/5/0 vs 11/17/17/0; P < .001) and limb movement (40/5/0/0 vs 28/17/0/0; P < .001) were lower in the P/S group than in the TIVA group. Besides, incremental fentanyl bolus for cough reflex was 5 (0 [0-1]) in the P/S group and 17 (0 [0-3]) in the TIVA group (P < .05). And there was no conversion to general anesthesia, postoperative hemorrhage, aspiration pneumonia, or PONV in the 2 groups. Besides, there was no significant difference in extubation time (TIVA: 5.04 ± 2.88 vs P/S: 4.44 ± 2.98 minutes; P = .33).
CONCLUSION: Sevoflurane attenuated cough reflex under propofol-based TIVA and did not increase the incidence of PONV and extubation time in nonintubated VATS.
背景：非插管胸腔镜手术近年来得到了广泛的发展。咳嗽反射是接近肺部病灶时不可避免的问题，可能引起大出血。七氟醚麻醉可通过抑制肺刺激受体来减轻咳嗽反射。然而，吸入麻醉术后恶心呕吐(PONV)的发生率高于基于丙泊酚的全静脉麻醉(TIVA)。我们研究了七氟醚联合基于丙泊酚的全静脉麻醉(TIVA)对非插管胸腔镜手术中咳嗽反射和PONV的影响。
方法：随机选择90例喉罩气道(LMA)非插管胸腔镜手术和自主呼吸的患者进行TIVA或者异丙酚/七氟醚麻醉。TIVA组(n = 45)采用异丙酚、芬太尼麻醉诱导维持;丙泊酚/七氟醚(P/S)组(n = 45)采用丙泊酚/芬太尼麻醉加1%七氟醚麻醉。主要测量结果是咳嗽反射。此外，我们还研究了PONV的发生率和拔管时间。
结果：P/S组咳嗽反射患者明显少于TIVA组(10/45 vs 34/45;P <0.001)。咳嗽严重程度(35/5/5/0 vs 11/17/17/0;P <0 .001)和肢体运动(40/5/0/0 vs 28/17/0/0;P < 0.001) P/S组较TIVA组低。P/S组使用芬太尼止咳丸5个 (0 [0-1])，TIVA组使用芬太尼止咳丸17 个(0 [0-3])(P <0 .05)。两组患者均未发生转用全身麻醉、术后出血、吸入性肺炎或PONV的情况。此外,两组患者在拔管时间上没有显著差异(TIVA: 5.04±2.88 vs P / S: 4.44±2.98分钟;P =0 .33)。
结论：七氟醚联合基于丙泊酚的全静脉麻醉(TIVA)可减弱咳嗽反射，并且不会增加未插管胸腔镜手术PONV的发生率和拔管时间。
（中日友好医院呼吸与危重症医学科 禹汶伯 摘译 林江涛 审校)
(Medicine (Baltimore). 2018 Oct;97(42).)
(Medicine (Baltimore). 2018 Oct;97(42).)
Sevoflurane is an effective adjuvant to propofol-based total intravenous anesthesia for attenuating cough reflex in nonintubated video-assisted thoracoscopic surgery.
Lai HC1, Huang TW2, Tseng WC1, Lin WL1, Chang H2, Wu ZF1.
Abstract
BACKGROUND: Nonintubated video-assisted thoracic surgery (VATS) has been widely developed during the recent years. Cough reflex is an inevitably encountered problem while approaching lung lesions, and it may induce major bleeding. Sevoflurane anesthesia may attenuate cough reflex by inhibiting the pulmonary irritant receptors. However, the incidence of postoperative nausea and vomiting (PONV) in inhalational anesthesia is higher than in the propofol-based total intravenous anesthesia (TIVA). We investigated the effect of sevoflurane combination with propofol-based TIVA on cough reflex and PONV in nonintubated VATS.
METHODS: Ninety patients undergoing nonintubated VATS with laryngeal mask airway (LMA) and spontaneous breathing were randomly assigned for TIVA or propofol/sevoflurane anesthesia. In the TIVA group (n = 45), anesthesia was induced and maintained with propofol and fentanyl; in the propofol/sevoflurane (P/S) group (n = 45), 1% sevoflurane anesthesia was added to propofol and fentanyl anesthesia. The primary outcome measurements were cough reflex. In addition, the incidence of PONV and extubation time were investigated.
RESULTS: Patients with cough reflex were significantly fewer in the P/S group than in the TIVA group (10/45 vs 34/45; P < .001). The cough severity (35/5/5/0 vs 11/17/17/0; P < .001) and limb movement (40/5/0/0 vs 28/17/0/0; P < .001) were lower in the P/S group than in the TIVA group. Besides, incremental fentanyl bolus for cough reflex was 5 (0 [0-1]) in the P/S group and 17 (0 [0-3]) in the TIVA group (P < .05). And there was no conversion to general anesthesia, postoperative hemorrhage, aspiration pneumonia, or PONV in the 2 groups. Besides, there was no significant difference in extubation time (TIVA: 5.04 ± 2.88 vs P/S: 4.44 ± 2.98 minutes; P = .33).
CONCLUSION: Sevoflurane attenuated cough reflex under propofol-based TIVA and did not increase the incidence of PONV and extubation time in nonintubated VATS.
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