右美托咪定用于保留自主呼吸支气管镜检查患者的镇痛镇静效应
发布时间：2018-09-04 09:52
【摘要】：目的:肺部、支气管等部位的病变需要通过纤维支气管镜检查进行诊断,要顺利完成镜检需要实施有效的麻醉。近年来全身麻醉在支气管镜检查及治疗中得到广泛应用,丙泊酚联合咪达唑仑、阿片类为常用组合药物,但丙泊酚、阿片类药物呼吸循环抑制明显甚至有组胺释放的可能,尤其对本身已有心血管疾病或肺支气管疾病的患者来说,风险较大。右美托咪定是高选择性α2受体激动剂,其镇痛镇静而不明显抑制呼吸的特点适合时间短、需要保留自主呼吸的支气管镜检查患者。因此,本研究主要探讨对术中保留自主呼吸的支气管镜检查患者运用右美托咪定的有效性和安全性。方法:选择2015年1月到2016年1月本院收治的呼吸系统疾病患者160例,所有患者都进行保留自主呼吸的支气管镜检查,签署麻醉知情同意书,将患者随机分为观察组和对照组各80例。观察组用高氧驱动面罩雾化吸入2%的利多卡因5m L以实施表面麻醉,后应用右美托咪定进行麻醉,按照1.0μg/kg计算出药物总量,采用微量注射泵在十分钟内匀速泵入诱导剂量,术中按0.2μg/kg.h静脉泵注维持。对照组应用高氧驱动面罩雾化吸入2%利多卡因5m L,速度保持在7L/min,并用2%的利多卡因3m L进行环甲膜穿刺局部麻醉。两组患者术中均用吸氧瓶连接高压氧以3L/min流量吸入高浓度氧气。记录两组患者在实施麻醉前(T1)、支气管镜检前(T2)、支气管镜插入声门(T3)、插入支气管即刻(T4)以及检查结束时(T5)5个时间点的平均动脉压(MAP)、心率(HR)、血氧饱和度(SPO2)变化情况,监测患者的各项麻醉情况以及生理指标,在此基础上全面评定两组患者的麻醉效果,并记录检查期间两组患者出现不良反应的情况并进行对比分析。总结右美托咪定用于无痛支气管镜检查期间对患者的麻醉效果和镇痛镇静效果。两组患者的统计数据采用SPSS 11.0进行分析,计量资料数据以均数±标准差((x|-)±s)表示,组间比较采用t检验,组内比较用方差分析。计数资料以率表示,采用x2检验。以P0.05为差异有统计学意义。结果:1.两组患者在性别、年龄、病情等一般资料方面的比较,差异无统计学意义(P0.05)。对两组患者的手术时间进行比较,发现观察组患者的平均手术时间为(13.25±4.13)min,对照组患者的平均手术时间为(19.36±5.65)min,结果显示:观察组患者手术时间明显小于对照组,差异具有统计学意义(P0.05)。比较两组患者的MAP、HR、SPO2水平。统计分析两组患者在各个时间点的具体数据,结果显示观察组与对照组在T1时间点的平均动脉压(MAP)、心率(HR)、血氧饱和度(SPO2)分别是(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)%,此时两组患者的各项数据无显著差异,但是在T2到T5阶段对照组患者的平均动脉压(MAP)、心率(HR)呈现出逐步上升的趋势,说明患者在手术过程中出现了较为严重的应激反应,观察组数据显示从T2时间点开始患者的心率(HR)减慢,同时平均动脉压(MAP)出现降低,此时两组患者之间的差异具有统计学意义(P0.05);在T2时间点对照组数据显示患者平均动脉压(MAP)、心率(HR)出现上升趋势,尤其是心率(HR),由T1的(78.55±8.34)次/min上升至(97.25±10.39)次/min,观察组患者平均动脉压(MAP)、心率(HR)在T2时间点出现下降,分别由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,说明在药物作用下,观察组患者的平均动脉压和心率逐步下降,两组患者的数据进行比较,差异具有统计学意义(P0.05);观察组与对照组在T1时间点血氧饱和度(SPO2)比较差异无统计学意义(P0.05),但是到了T4时间点对照组患者血氧饱和度(SPO2)出现较大下降,与观察组比较差异具有统计学意义(P0.05)。推测为对照组进镜至支气管后诱发了不同程度的呛咳、气道痉挛和排异反应。比较两组患者的麻醉效果。对两组患者实施麻醉以后,观察组应用右美托咪定进行诱导实施清醒麻醉,为患者进行检查前,观察组患者的Ramsay评分均大于4分,检查过程中患者具有清醒的意识,可以有效配合各项检查活动,同时患者舒适度较高;对照组患者保持清醒状态,但是对于检查的配合能力较差。进一步比较两组患者的麻醉效果,观察组患者优24例、良30例,而对照组优16例、良26例,两组之间的差异具有统计学意义(P0.05),说明观察组的麻醉效果明显优于对照组。比较两组患者在检查期间出现不良反应的发生情况。在检查过程中观察组出现10例不良反应,分别是躁动3例、呛咳2例、心律失常2例、憋气1例、咳血2例;对照组出现40例不良反应,分别是躁动15例、呛咳6例、心律失常3例、憋气3例、咳血5例、支气管痉挛3例、鼻出血2例、检查中断3例,说明观察组患者在检查期间的不良反应发生情况明显低于对照组,差异具有统计学意义(P0.05)。结论:对需要实施支气管镜检查的患者应用右美托咪定进行麻醉,可以达到良好的麻醉效果,而且检查期间患者的平均动脉压(MAP)、心率(HR)趋向平稳,同时血氧饱和度(SPO2)无较大变化。应用右美托咪定进行麻醉还可以提高患者在检查过程中的舒适度,同时有助于患者积极配合检查,促使检查顺利完成,检查过程中患者出现不良反应少。
[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.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614
，
本文编号：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.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614
，
本文编号：2221735
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