布托啡诺不同给药方法用于纤维支气管镜检查术麻醉的效果比较

Comparison of anesthetic effects of intranasal and intravenous butorphanol application in fiberoptic bronchoscopy

目的:探讨布托啡诺经鼻腔给药和静脉注射用于纤维支气管镜检查术的可行性。方法:行纤维支气管镜检查术的患者80例,随机均分为经鼻腔给药组(A组)、静脉注射组(B组),布托啡诺20μg/kg分别经鼻滴入、经静脉注射。用药后2 min均缓慢静脉注射丙泊酚1～3 mg/kg,待患者意识消失、睫毛反射消失即开始检查,持续泵注丙泊酚50μg.kg-1.min-1,术中视患者情况酌情追加丙泊酚0.5～1.0 mg/kg。记录用药前(T0)、用药后1 min(T1)、静脉注射丙泊酚后1 min(T2)、纤维支气管镜进入鼻道(T3)、进入声门(T4)、进入主支气管(T5)、进入叶支气管(T6)、活检(T7)、术毕(T8)、清醒(T9)时的MAP、HR、SpO2,诱导时间、检查持续时间、呛咳情况、肢动情况、苏醒时间。术中以利多卡因、麻黄碱、艾司络尔对症治疗,并记录用药次数、术后恶心、呕吐、嗜睡等情况。结果:两组MAP、HR在T1～T9较T0低,组间比较差异无统计学意义(P>0.05);两组SpO2在T2～T7较T0、T1、T8、T9低,但SpO2在T2～T7时A组明显高于B组(P<0.05)。A组麻醉效果明显优于B组(P<0.05)。A组术者满意度明显高于B组(P<0.05)。患者舒适度差异无统计学意义(P>0.05)。两组均未出现SpO2<85%、心律失常及肢动等。诱导时间、苏醒时间、检查持续时间两组差异无统计学意义(P>0.05)。结论:布托啡诺经鼻腔给药用于纤维支气管镜检查术的效果优于静脉注射。

Objective：To investigate the feasibility of intranasal and intravenous butorphanol application in fiberoptic bronchoscopy. Methods：80 cases undergoing fiberoptic bronchoscopy were divided into two groups randomly and evenly,40 cases in each group. The gruup A and group B received anesthetic induction with butorphanol 20 μg/kg by intranasal dripping or intravenous injection respectively. After 2 min, propofol 1-3 mg/kg was given by intravenous injection until consciousness and eyelashes reflex disappearing, and propofol 50μg·kg^-1·min^-1 was infused by pump to maintain anesthesia. According to the condition, propofol 0.5-1.0 mg/kg was added during opera- tion.MAP, HR,SpO2 were recorded before the induction of anesthesia（T0）, 1 min after induction（T1） and 1 min after intravenous propofol （T2）,the fiberbronchoscope reaching the nasopharynx （T3）,reacbing the glottis （T4）,reacbing the main bronchus （T5）,reaching the lobar bronchus（T6）, during biopsy（T7）, at the end of operation（T8） and awaking（T9）.The minimum of body movement ,the time of recovery and the side effects were recorded.Results：MAP and HR at T1-T9 in two groups were lower than those at To. SpO2 at T2-T7 in two groups were lower than that at T0,T1,T8 and T9（P〈0.05）,but SpO2 at T2-T7 in the group A was higher than that at the same time points in the group B （P〈0.05）.The patients in the group A was more stable compared with the group B. The satisfaction of physicians was higher in the group A. There were no adverse events of SPO2〈85%, abnormal heart rate and body movement in two groups. The induction time,awaking time and detection duration had no statistical difference between the two groups（P〉0.05）. Conclusion：Intranasal butorphanol is safer and more effective than giving butorphanol by intravenous injection in fiberoptic bronchoscopy.