右美托咪定注射液滴鼻在无痛纤维支气管镜检查中的应用研究
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摘要
目的探讨右美托咪定注射液滴鼻在无痛纤维支气管镜检查中的应用。方法选择2017年1～5月在我院行择期无痛纤维支气管镜检查的80例患者作为研究对象,年龄18～75岁,ASAⅠ～Ⅲ级,将其随机分为右美托咪定滴鼻组(D组)和生理盐水对照组(C组),每组各40例。记录两组患者休息10 min后(T0)、纤维支气管镜过声门后到达隆突前(T_1)、检查结束时(T_2)的平均动脉压(MAP)及心率(HR),并比较两组患者的呛咳体动视觉模拟(VAS)综合评分、不良事件(低血压、高血压、心动过缓、心动过速)发生率、丙泊酚使用总量、苏醒时间及Ricker镇静-躁动(SAS)评分。结果两组患者T0的MAP、HR比较,差异无统计学意义(P>0.05);两组患者T_1的MAP均高于T_0,差异有统计学意义(P<0.05);C组患者T_1的HR显著高于T_0,差异有统计学意义(P<0.05);D组患者T_1的HR低于C组,差异有统计学意义(P<0.05);两组患者T_2的MAP、HR比较,差异无统计学意义(P>0.05)。D组患者的呛咳体动VAS综合评分为(4.2±1.6)分,心动过速发生率为12.5%,均分别显著低于C组的(5.6±1.8)分、22.5%,差异有统计学意义(P<0.05);两组患者的低血压、高血压、心动过缓发生率比较,差异无统计学意义(P>0.05)。D组患者的丙泊酚使用总量为(125.1±40.6)mg,显著少于C组的(138.2±31.5)mg,恢复室SAS评分为(3.9±0.5)分,显著低于C组的(4.8±0.6)分,差异有统计学意义(P<0.05);D组患者的苏醒时间为(15.2±3.9)min,与C组的(15.8±4.2)min比较,差异无统计学意义(P>0.05)。结论右美托咪定注射液滴鼻可安全有效地应用于全麻无痛纤维支气管镜检查中,相较于传统方法 ,检查过程及恢复过程更为平稳,丙泊酚用量更少,且不影响苏醒时间。
Objective To explore the application of Dexmedetomidine Injection nasal drops in the examination of painless fiberoptic bronchoscopy. Methods Eighty patients who underwent elective painless fiberoptic bronchoscopy in our hospital from January to May 2017 were enrolled in the study, whose ages were 18 to 75 years old, with ASA Ⅰ～Ⅲ. They were randomly divided into Dexmedetomidine nasal drops group(group D) and saline control group(group C), 40 cases in each group. The mean arterial pressure(MAP) and heart rate(HR) in the two groups of patients after 10 minutes of rest(T_0), fiberoptic bronchoscopy after passing the glottis and before reaching the bulge(T_1) and at the end of the examination(T_2) were recorded. The cough and body motion visual analogue scale(VAS) comprehensive score, incidence of adverse events(hypotension, hypertension, bradycardia and tachycardia), total use of Propofol, wake time, and Ricker sedation-incitement(SAS) score were compared between the two groups. Results There were no significant differences in the MAP and HR between the two groups at T_0(P>0.05). The MAP of T_1 in both groups was higher than that of T0,and the difference was statistically significant(P<0.05). The HR of T_1 in group C was significantly higher than that of T_0, and the difference was statistically significant(P<0.05). The HR of T_1 in group D was lower than that in group C,and the difference was statistically significant(P<0.05). There were no significant differences in MAP and HR between the two groups at T_2(P>0.05). The comprehensive score of cough and body motion VAS in group D was(4.2 ±1.6)points, the rate of tachycardia was 12.5%, which was significantly lower than those of group C for(5.6±1.8) points and22.5% respectively, and the differences were statistically significant(P<0.05). There were no significant differences in the incidence rates of hypotension, hypertension, and bradycardia between the two groups(P>0.05). The total amount of Propofol used in group D was(125.1±40.6) mg, which was significantly less than that in group C for(138.2±31.5) mg,the SAS score of recovery room in group D was(3.9±0.5) points, which was significantly lower than that in group C for(4.8±0.6) points, and the differences were statistically significant(P<0.05). The wake time of patients in group D was(15.2±3.9) min, compared with(15.8±4.2) min in group C, and the difference was not statistically significant(P>0.05).Conclusion Dexmedetomidine Injection nasal drops can be safely and effectively applied to in the examination of general anesthesia painless fiberoptic bronchoscopy, compared with traditional methods, the inspection process and recovery process are more stable, and the amount of Propofol is less, which does not affect the wake time.
Objective To explore the application of Dexmedetomidine Injection nasal drops in the examination of painless fiberoptic bronchoscopy. Methods Eighty patients who underwent elective painless fiberoptic bronchoscopy in our hospital from January to May 2017 were enrolled in the study, whose ages were 18 to 75 years old, with ASA Ⅰ～Ⅲ. They were randomly divided into Dexmedetomidine nasal drops group(group D) and saline control group(group C), 40 cases in each group. The mean arterial pressure(MAP) and heart rate(HR) in the two groups of patients after 10 minutes of rest(T_0), fiberoptic bronchoscopy after passing the glottis and before reaching the bulge(T_1) and at the end of the examination(T_2) were recorded. The cough and body motion visual analogue scale(VAS) comprehensive score, incidence of adverse events(hypotension, hypertension, bradycardia and tachycardia), total use of Propofol, wake time, and Ricker sedation-incitement(SAS) score were compared between the two groups. Results There were no significant differences in the MAP and HR between the two groups at T_0(P>0.05). The MAP of T_1 in both groups was higher than that of T0,and the difference was statistically significant(P<0.05). The HR of T_1 in group C was significantly higher than that of T_0, and the difference was statistically significant(P<0.05). The HR of T_1 in group D was lower than that in group C,and the difference was statistically significant(P<0.05). There were no significant differences in MAP and HR between the two groups at T_2(P>0.05). The comprehensive score of cough and body motion VAS in group D was(4.2 ±1.6)points, the rate of tachycardia was 12.5%, which was significantly lower than those of group C for(5.6±1.8) points and22.5% respectively, and the differences were statistically significant(P<0.05). There were no significant differences in the incidence rates of hypotension, hypertension, and bradycardia between the two groups(P>0.05). The total amount of Propofol used in group D was(125.1±40.6) mg, which was significantly less than that in group C for(138.2±31.5) mg,the SAS score of recovery room in group D was(3.9±0.5) points, which was significantly lower than that in group C for(4.8±0.6) points, and the differences were statistically significant(P<0.05). The wake time of patients in group D was(15.2±3.9) min, compared with(15.8±4.2) min in group C, and the difference was not statistically significant(P>0.05).Conclusion Dexmedetomidine Injection nasal drops can be safely and effectively applied to in the examination of general anesthesia painless fiberoptic bronchoscopy, compared with traditional methods, the inspection process and recovery process are more stable, and the amount of Propofol is less, which does not affect the wake time.
引文
[1]黄锡强,苏圣贤,张志刚,等.Narcotrend麻醉深度监测在无痛纤维支气管镜检查中的临床应用[J].海南医学,2013,24(4):514-516.
[2]Kaur H,Dhooria S,Aggarwal AN,et al.A randomized trial of1%vs 2%Lignocaine by the spray-as-you-go technique for topical anesthesia during flexible bronchoscopy[J].Chest,2015,148(3):739-745.
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[5]张永谦,柳娟,岳云.内镜面罩与双管喉罩在老年患者无痛纤维支气管镜检查中的应用[J].国际麻醉与复苏杂志,2011,32(5):546-548.
[6]苗虎,马福莉,刘小敏.静脉符合丙泊酚联合三通喉罩在行无痛纤维支气管镜检查的应用[J].辽宁医学院学报,2015,36(2):13-15.
[7]杨德茂,王鑫.丙泊酚与舒芬太尼联合行无痛性纤维支气管镜临床应用分析[J].实用医技杂志,2006,13(8):1301-1302.
[8]徐斐.盐酸右美托咪定的临床应用[J].中国循环杂志,2015,30(4):401-403.
[9]王建东,姚上华,张广林,等.右美托咪定在全麻无痛气管镜中的运用探讨[J].临床肺科杂志,2016,21(1):84-87.
[10]夏伟鹏,邓晓明.右美托咪定滴鼻用于麻醉的研究进展[J].蚌埠医学院学报,2014,39(3):415-417.
[11]庄晴,朱云霞,唐季春,等.小剂量右美托咪定滴鼻在普通胃镜中应用[J].中国血液流变学杂志,2015,25(3):310-312.
[12]刘诚,陈慧,周慧珍,等.不同剂量右美托咪定术前滴鼻在小儿麻醉中的应用[J].全科医学临床与教育,2013,11(5):557-559.
[13]戚剑敏,陈骏萍,任海珍,等.右美托咪定滴鼻用于无痛人工流产术的临床观察[J].现代实用医学,2014,26(3):267-268.
[14]Yuen VM,Hui TW,Irwin MG,et al.A comparison of intranasal dexmedetomidine and oral midazolam for premedication in pediatric anesthesia:a double-blinded randomized controlled trial[J].Anesth Analg,2008,106(6):1715-1721.
[15]杨晓旭,王云明.右美托咪定临床应用新进展[J].中国中西医结合急救杂志,2014,21(2):152-154.
[16]张妍,姜利军,朱吉祥,等.右美托咪定用于重症监护病房躁动患者的临床观察[J].中国危重病急救医学,2011,23(7):439-440.
[2]Kaur H,Dhooria S,Aggarwal AN,et al.A randomized trial of1%vs 2%Lignocaine by the spray-as-you-go technique for topical anesthesia during flexible bronchoscopy[J].Chest,2015,148(3):739-745.
[3]刘宇霞.无痛纤维支气管镜检查与常规纤维支气管镜检查的临床效果对比探讨[J].中国医药指南,2012,10(29):181.
[4]雷勇静,陈传英,刘晓彬,等.无痛纤维支气管镜检查的麻醉进展[J].中国医师进修杂志,2014,37(12):74-76.
[5]张永谦,柳娟,岳云.内镜面罩与双管喉罩在老年患者无痛纤维支气管镜检查中的应用[J].国际麻醉与复苏杂志,2011,32(5):546-548.
[6]苗虎,马福莉,刘小敏.静脉符合丙泊酚联合三通喉罩在行无痛纤维支气管镜检查的应用[J].辽宁医学院学报,2015,36(2):13-15.
[7]杨德茂,王鑫.丙泊酚与舒芬太尼联合行无痛性纤维支气管镜临床应用分析[J].实用医技杂志,2006,13(8):1301-1302.
[8]徐斐.盐酸右美托咪定的临床应用[J].中国循环杂志,2015,30(4):401-403.
[9]王建东,姚上华,张广林,等.右美托咪定在全麻无痛气管镜中的运用探讨[J].临床肺科杂志,2016,21(1):84-87.
[10]夏伟鹏,邓晓明.右美托咪定滴鼻用于麻醉的研究进展[J].蚌埠医学院学报,2014,39(3):415-417.
[11]庄晴,朱云霞,唐季春,等.小剂量右美托咪定滴鼻在普通胃镜中应用[J].中国血液流变学杂志,2015,25(3):310-312.
[12]刘诚,陈慧,周慧珍,等.不同剂量右美托咪定术前滴鼻在小儿麻醉中的应用[J].全科医学临床与教育,2013,11(5):557-559.
[13]戚剑敏,陈骏萍,任海珍,等.右美托咪定滴鼻用于无痛人工流产术的临床观察[J].现代实用医学,2014,26(3):267-268.
[14]Yuen VM,Hui TW,Irwin MG,et al.A comparison of intranasal dexmedetomidine and oral midazolam for premedication in pediatric anesthesia:a double-blinded randomized controlled trial[J].Anesth Analg,2008,106(6):1715-1721.
[15]杨晓旭,王云明.右美托咪定临床应用新进展[J].中国中西医结合急救杂志,2014,21(2):152-154.
[16]张妍,姜利军,朱吉祥,等.右美托咪定用于重症监护病房躁动患者的临床观察[J].中国危重病急救医学,2011,23(7):439-440.