右美托咪定用于保留自主呼吸支氣管鏡檢查患者的鎮(zhèn)痛鎮(zhèn)靜效應
發(fā)布時間：2018-09-04 09:52
【摘要】：目的:肺部、支氣管等部位的病變需要通過纖維支氣管鏡檢查進行診斷,要順利完成鏡檢需要實施有效的麻醉。近年來全身麻醉在支氣管鏡檢查及治療中得到廣泛應用,丙泊酚聯(lián)合咪達唑侖、阿片類為常用組合藥物,但丙泊酚、阿片類藥物呼吸循環(huán)抑制明顯甚至有組胺釋放的可能,尤其對本身已有心血管疾病或肺支氣管疾病的患者來說,風險較大。右美托咪定是高選擇性α2受體激動劑,其鎮(zhèn)痛鎮(zhèn)靜而不明顯抑制呼吸的特點適合時間短、需要保留自主呼吸的支氣管鏡檢查患者。因此,本研究主要探討對術中保留自主呼吸的支氣管鏡檢查患者運用右美托咪定的有效性和安全性。方法:選擇2015年1月到2016年1月本院收治的呼吸系統(tǒng)疾病患者160例,所有患者都進行保留自主呼吸的支氣管鏡檢查,簽署麻醉知情同意書,將患者隨機分為觀察組和對照組各80例。觀察組用高氧驅(qū)動面罩霧化吸入2%的利多卡因5m L以實施表面麻醉,后應用右美托咪定進行麻醉,按照1.0μg/kg計算出藥物總量,采用微量注射泵在十分鐘內(nèi)勻速泵入誘導劑量,術中按0.2μg/kg.h靜脈泵注維持。對照組應用高氧驅(qū)動面罩霧化吸入2%利多卡因5m L,速度保持在7L/min,并用2%的利多卡因3m L進行環(huán)甲膜穿刺局部麻醉。兩組患者術中均用吸氧瓶連接高壓氧以3L/min流量吸入高濃度氧氣。記錄兩組患者在實施麻醉前(T1)、支氣管鏡檢前(T2)、支氣管鏡插入聲門(T3)、插入支氣管即刻(T4)以及檢查結束時(T5)5個時間點的平均動脈壓(MAP)、心率(HR)、血氧飽和度(SPO2)變化情況,監(jiān)測患者的各項麻醉情況以及生理指標,在此基礎上全面評定兩組患者的麻醉效果,并記錄檢查期間兩組患者出現(xiàn)不良反應的情況并進行對比分析。總結右美托咪定用于無痛支氣管鏡檢查期間對患者的麻醉效果和鎮(zhèn)痛鎮(zhèn)靜效果。兩組患者的統(tǒng)計數(shù)據(jù)采用SPSS 11.0進行分析,計量資料數(shù)據(jù)以均數(shù)±標準差((x|-)±s)表示,組間比較采用t檢驗,組內(nèi)比較用方差分析。計數(shù)資料以率表示,采用x2檢驗。以P0.05為差異有統(tǒng)計學意義。結果:1.兩組患者在性別、年齡、病情等一般資料方面的比較,差異無統(tǒng)計學意義(P0.05)。對兩組患者的手術時間進行比較,發(fā)現(xiàn)觀察組患者的平均手術時間為(13.25±4.13)min,對照組患者的平均手術時間為(19.36±5.65)min,結果顯示:觀察組患者手術時間明顯小于對照組,差異具有統(tǒng)計學意義(P0.05)。比較兩組患者的MAP、HR、SPO2水平。統(tǒng)計分析兩組患者在各個時間點的具體數(shù)據(jù),結果顯示觀察組與對照組在T1時間點的平均動脈壓(MAP)、心率(HR)、血氧飽和度(SPO2)分別是(95.25±2.50)mm Hg、(79.45±8.10)次/min、(98.20±1.44)%,(95.25±8.28)mm Hg、(79.54±8.23)次/min、(98.34±1.52)%,此時兩組患者的各項數(shù)據(jù)無顯著差異,但是在T2到T5階段對照組患者的平均動脈壓(MAP)、心率(HR)呈現(xiàn)出逐步上升的趨勢,說明患者在手術過程中出現(xiàn)了較為嚴重的應激反應,觀察組數(shù)據(jù)顯示從T2時間點開始患者的心率(HR)減慢,同時平均動脈壓(MAP)出現(xiàn)降低,此時兩組患者之間的差異具有統(tǒng)計學意義(P0.05);在T2時間點對照組數(shù)據(jù)顯示患者平均動脈壓(MAP)、心率(HR)出現(xiàn)上升趨勢,尤其是心率(HR),由T1的(78.55±8.34)次/min上升至(97.25±10.39)次/min,觀察組患者平均動脈壓(MAP)、心率(HR)在T2時間點出現(xiàn)下降,分別由T1的(95.25±2.50)mm Hg、(79.45±8.10)次/min下降至(90.21±8.32)mm Hg、(70.14±8.45)次/min,說明在藥物作用下,觀察組患者的平均動脈壓和心率逐步下降,兩組患者的數(shù)據(jù)進行比較,差異具有統(tǒng)計學意義(P0.05);觀察組與對照組在T1時間點血氧飽和度(SPO2)比較差異無統(tǒng)計學意義(P0.05),但是到了T4時間點對照組患者血氧飽和度(SPO2)出現(xiàn)較大下降,與觀察組比較差異具有統(tǒng)計學意義(P0.05)。推測為對照組進鏡至支氣管后誘發(fā)了不同程度的嗆咳、氣道痙攣和排異反應。比較兩組患者的麻醉效果。對兩組患者實施麻醉以后,觀察組應用右美托咪定進行誘導實施清醒麻醉,為患者進行檢查前,觀察組患者的Ramsay評分均大于4分,檢查過程中患者具有清醒的意識,可以有效配合各項檢查活動,同時患者舒適度較高;對照組患者保持清醒狀態(tài),但是對于檢查的配合能力較差。進一步比較兩組患者的麻醉效果,觀察組患者優(yōu)24例、良30例,而對照組優(yōu)16例、良26例,兩組之間的差異具有統(tǒng)計學意義(P0.05),說明觀察組的麻醉效果明顯優(yōu)于對照組。比較兩組患者在檢查期間出現(xiàn)不良反應的發(fā)生情況。在檢查過程中觀察組出現(xiàn)10例不良反應,分別是躁動3例、嗆咳2例、心律失常2例、憋氣1例、咳血2例;對照組出現(xiàn)40例不良反應,分別是躁動15例、嗆咳6例、心律失常3例、憋氣3例、咳血5例、支氣管痙攣3例、鼻出血2例、檢查中斷3例,說明觀察組患者在檢查期間的不良反應發(fā)生情況明顯低于對照組,差異具有統(tǒng)計學意義(P0.05)。結論:對需要實施支氣管鏡檢查的患者應用右美托咪定進行麻醉,可以達到良好的麻醉效果,而且檢查期間患者的平均動脈壓(MAP)、心率(HR)趨向平穩(wěn),同時血氧飽和度(SPO2)無較大變化。應用右美托咪定進行麻醉還可以提高患者在檢查過程中的舒適度,同時有助于患者積極配合檢查,促使檢查順利完成,檢查過程中患者出現(xiàn)不良反應少。
[Abstract]:Objective: The pathological changes of lung and bronchus need to be diagnosed by fiberoptic bronchoscopy, and effective anesthesia is needed to complete the examination smoothly. In recent years, general anesthesia has been widely used in bronchoscopy examination and treatment. Propofol combined with midazolam, opioids are commonly used combination drugs, but propofol, opioids. Respiratory and circulatory depression is obvious and even histamine may be released, especially in patients with existing cardiovascular or pulmonary bronchial diseases. dexmedetomidine is a highly selective alpha 2 receptor agonist. Its analgesic, sedative and non-inhibitive respiratory characteristics are suitable for a short period of time. Bronchoscopy with autonomous respiration is necessary. Methods: 160 patients with respiratory diseases admitted to our hospital from January 2015 to January 2016 were enrolled in this study. All patients underwent bronchoscopy with spontaneous breathing and signed anesthesia information. The patients were randomly divided into the observation group and the control group with 80 cases in each group. In the control group, 2% lidocaine 5mL was inhaled by atomization with a hyperoxia-driven mask at a speed of 7L/min and local anesthesia was performed with 2% lidocaine 3mL. In both groups, hyperbaric oxygen was connected with a suction bottle to inhale high concentration oxygen at a flow rate of 3L/min. The changes of mean arterial pressure (MAP), heart rate (HR) and blood oxygen saturation (SPO2) at 5 time points before tracheoscopy (T2), the insertion of glottis (T3), the insertion of bronchus (T4) and at the end of tracheoscopy (T5) were monitored. The anesthetic effects of the two groups were evaluated and recorded. The anesthetic effect and sedative effect of dexmedetomidine used in painless bronchoscopy were summarized. The statistical data of the two groups were analyzed by SPSS 11.0. The measurement data were expressed by mean ((x | -) + s) and compared between groups. Results: 1. There was no significant difference between the two groups in terms of sex, age, condition and other general information (P 0.05). The operation time of the two groups was compared, and the average operation time of the observation group was found. The operation time was (13.25 + 4.13) minutes, and the average operation time of the control group was (19.36 + 5.65) minutes. The results showed that the operation time of the observation group was significantly shorter than that of the control group, and the difference was statistically significant (P 0.05). Mean arterial pressure (MAP), heart rate (HR), and oxygen saturation (SPO2) were (95.25 (+ 2.50) mm Hg, (79.45 (+ 8.10) times/min, (98.20 (+ 1.44)%, (95.25 (+ 8.28) mm Hg, (79.54 (+ 8.23) times/min, (98.34 (+ 1.52)) at T1 time point in the two groups, respectively. Mean arterial pressure (MAP) and heart rate (HR) showed a gradual upward trend, indicating that patients had more serious stress reaction during the operation. Observation group data showed that patients'heart rate (HR) slowed down from T2 time point, while mean arterial pressure (MAP) decreased, at this time the difference between the two groups was statistically significant (P 0.05); Mean arterial pressure (MAP) and heart rate (HR) of the patients in the control group showed an upward trend, especially heart rate (HR), which increased from (78.55 [8.34]/ min of T1 to (97.25 [10.39]/ min. Mean arterial pressure (MAP) and heart rate (HR) of the patients in the observation group decreased from (95.25 [2.50] mm Hg of T1 to (79.45 [8.10]/ min of T1 respectively. The mean arterial pressure and heart rate of the patients in the observation group gradually decreased under the action of drugs, and the difference between the two groups was statistically significant (P 0.05). There was no significant difference between the observation group and the control group in blood oxygen saturation (SPO2) at T1 time point (P 0.05), but to T. The blood oxygen saturation (SPO2) of the control group decreased significantly at 4 time points, which was significantly different from that of the observation group (P 0.05). It was presumed that the control group induced different degrees of cough, airway spasm and rejection after bronchoscopy. The anesthetic effects of the two groups were compared. After anesthesia, the observation group was applied. The Ramsay scores of the patients in the observation group were all higher than 4 before the examination. The patients in the observation group were conscious and could effectively cooperate with various examination activities, while the patients in the control group were in a high degree of comfort. The anesthesia effect of the observation group was better than that of the control group (P 0.05). The occurrence of adverse reactions was compared between the two groups. There were 10 cases of adverse reactions in the control group, including 3 cases of agitation, 2 cases of choking cough, 2 cases of arrhythmia, 1 case of choking, 2 cases of hemoptysis, and 40 cases of adverse reactions in the control group, including 15 cases of agitation, 6 cases of choking, 3 cases of arrhythmia, 3 cases of choking, 5 cases of coughing blood, 3 cases of bronchospasm, 2 cases of epistaxis, and 3 cases of interruption of examination. Conclusion: The anesthesia effect of dexmedetomidine in patients who need bronchoscopy is good, and the mean arterial pressure (MAP) and heart rate (HR) tend to be stable during the examination, and the blood oxygen saturation (SPO2) is not significant. The application of dexmedetomidine anesthesia can also improve the comfort of patients in the process of examination, and help patients to actively cooperate with the examination, to facilitate the smooth completion of the examination, the examination process of patients with fewer adverse reactions.
【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R614
，
本文編號：2221735
[Abstract]:Objective: The pathological changes of lung and bronchus need to be diagnosed by fiberoptic bronchoscopy, and effective anesthesia is needed to complete the examination smoothly. In recent years, general anesthesia has been widely used in bronchoscopy examination and treatment. Propofol combined with midazolam, opioids are commonly used combination drugs, but propofol, opioids. Respiratory and circulatory depression is obvious and even histamine may be released, especially in patients with existing cardiovascular or pulmonary bronchial diseases. dexmedetomidine is a highly selective alpha 2 receptor agonist. Its analgesic, sedative and non-inhibitive respiratory characteristics are suitable for a short period of time. Bronchoscopy with autonomous respiration is necessary. Methods: 160 patients with respiratory diseases admitted to our hospital from January 2015 to January 2016 were enrolled in this study. All patients underwent bronchoscopy with spontaneous breathing and signed anesthesia information. The patients were randomly divided into the observation group and the control group with 80 cases in each group. In the control group, 2% lidocaine 5mL was inhaled by atomization with a hyperoxia-driven mask at a speed of 7L/min and local anesthesia was performed with 2% lidocaine 3mL. In both groups, hyperbaric oxygen was connected with a suction bottle to inhale high concentration oxygen at a flow rate of 3L/min. The changes of mean arterial pressure (MAP), heart rate (HR) and blood oxygen saturation (SPO2) at 5 time points before tracheoscopy (T2), the insertion of glottis (T3), the insertion of bronchus (T4) and at the end of tracheoscopy (T5) were monitored. The anesthetic effects of the two groups were evaluated and recorded. The anesthetic effect and sedative effect of dexmedetomidine used in painless bronchoscopy were summarized. The statistical data of the two groups were analyzed by SPSS 11.0. The measurement data were expressed by mean ((x | -) + s) and compared between groups. Results: 1. There was no significant difference between the two groups in terms of sex, age, condition and other general information (P 0.05). The operation time of the two groups was compared, and the average operation time of the observation group was found. The operation time was (13.25 + 4.13) minutes, and the average operation time of the control group was (19.36 + 5.65) minutes. The results showed that the operation time of the observation group was significantly shorter than that of the control group, and the difference was statistically significant (P 0.05). Mean arterial pressure (MAP), heart rate (HR), and oxygen saturation (SPO2) were (95.25 (+ 2.50) mm Hg, (79.45 (+ 8.10) times/min, (98.20 (+ 1.44)%, (95.25 (+ 8.28) mm Hg, (79.54 (+ 8.23) times/min, (98.34 (+ 1.52)) at T1 time point in the two groups, respectively. Mean arterial pressure (MAP) and heart rate (HR) showed a gradual upward trend, indicating that patients had more serious stress reaction during the operation. Observation group data showed that patients'heart rate (HR) slowed down from T2 time point, while mean arterial pressure (MAP) decreased, at this time the difference between the two groups was statistically significant (P 0.05); Mean arterial pressure (MAP) and heart rate (HR) of the patients in the control group showed an upward trend, especially heart rate (HR), which increased from (78.55 [8.34]/ min of T1 to (97.25 [10.39]/ min. Mean arterial pressure (MAP) and heart rate (HR) of the patients in the observation group decreased from (95.25 [2.50] mm Hg of T1 to (79.45 [8.10]/ min of T1 respectively. The mean arterial pressure and heart rate of the patients in the observation group gradually decreased under the action of drugs, and the difference between the two groups was statistically significant (P 0.05). There was no significant difference between the observation group and the control group in blood oxygen saturation (SPO2) at T1 time point (P 0.05), but to T. The blood oxygen saturation (SPO2) of the control group decreased significantly at 4 time points, which was significantly different from that of the observation group (P 0.05). It was presumed that the control group induced different degrees of cough, airway spasm and rejection after bronchoscopy. The anesthetic effects of the two groups were compared. After anesthesia, the observation group was applied. The Ramsay scores of the patients in the observation group were all higher than 4 before the examination. The patients in the observation group were conscious and could effectively cooperate with various examination activities, while the patients in the control group were in a high degree of comfort. The anesthesia effect of the observation group was better than that of the control group (P 0.05). The occurrence of adverse reactions was compared between the two groups. There were 10 cases of adverse reactions in the control group, including 3 cases of agitation, 2 cases of choking cough, 2 cases of arrhythmia, 1 case of choking, 2 cases of hemoptysis, and 40 cases of adverse reactions in the control group, including 15 cases of agitation, 6 cases of choking, 3 cases of arrhythmia, 3 cases of choking, 5 cases of coughing blood, 3 cases of bronchospasm, 2 cases of epistaxis, and 3 cases of interruption of examination. Conclusion: The anesthesia effect of dexmedetomidine in patients who need bronchoscopy is good, and the mean arterial pressure (MAP) and heart rate (HR) tend to be stable during the examination, and the blood oxygen saturation (SPO2) is not significant. The application of dexmedetomidine anesthesia can also improve the comfort of patients in the process of examination, and help patients to actively cooperate with the examination, to facilitate the smooth completion of the examination, the examination process of patients with fewer adverse reactions.
【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R614
，
本文編號：2221735
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