经支气管镜下局部灌注肾上腺素的安全性分析

Safety evaluation of instillation of epinephrine-saline solution through bronchoscope

目的：探讨支气管镜下滴注肾上腺素的安全性。方法74例中男52例，女22例，年龄20～78岁，平均年龄（53．08±12．43）岁，分为3组：①对照组27例，术前常规阿托品0．5mg肌肉注射，2％利多卡因表面麻醉。常规支气管镜检查及治疗。术中未使用肾上腺素。②大气道组32例，术前处理及支气管镜操作同对照组，但于术中向段以上支气管黏膜表面灌注1：20000肾上腺素溶液（2．28±1．49）ml。③小气道组15例，术前处理及支气管镜操作同对照组，于术中用2mm导管嵌于末梢支气管并向远端推注1：20000肾上腺素溶液（2．88士1．94）ml。三组间术前（给药前）基本情况具有可比性：年龄、术前收缩压、舒张压及心率差异均无统计学意义，大气道组与小气道组肾上腺素溶液用量差异亦无统计学意义。对三组病例于支气管镜检查前后的观测指标进行以下分析：①检查前后收缩压、舒张压、心率变化（自身对照）；②两两比较三组间检查前后收缩压差、舒张压差、心率差；③观察给予肾上腺素后其他相关不良反应的发生情况，包括心悸、胸闷、胸痛、苍白或潮红、头痛、肌肉震颤等。结果①术后收缩压、舒张压及一tL,率均有不同程度的增加（P＜0．05或P＜0．01）。②给药前后收缩压差刊、气道组差值〉大气道组差值〉对照组差值，小气道组收缩压差与后两组间比较差异有统计学意义（P＜0．05），小气道组心率差与对照组比较差异有统计学意义（P＜0．05）。其余组间差异均无统计学意义。各组舒张压差无显著差异。③大气道组及小气道组血压及心率变化均与肾上腺素用量无相关性（r。分别为0．008及0．18，P＞0．05）。④小气道组有不同比例患者出现心悸、心绞痛（3例）、震颤、皮肤潮红或苍白等。结论小气道内滴注肾上腺素可引起全身不良反应。

Objective To evaluate the safety of instillation of epinephrine-saline solution through bronchoscope. Methods 74 cases （52 male,22 male,20-78 years old, mean age 53.08±12.43 years） were divided into three groups： ①Control group （27 eases） ： routine preoperative 0.5 mg atropine was injected intramuscularly, 2% lidocaine was used for topical anesthesia, routine bronchoscopy was performed,without instillation of epinephrine-saline solution through bronchoscope. ②Central airways group （32 cases） ：preoperative treatment and bronchoscopy operation was performed as the control group, （2.28± 1.49） ml epinephrine-saline solution （1 ： 20 000） was instilled into bronchi proximal to segmental. ③Terminai airway group （15 cases） ：preoperative treatment and bronchoscopy operation was performed as the control group, （2.88± 1.94） ml epinephrine-saline solution （1 ： 20 000） was respectively instilled into peripheral bronchial by catheter with diameter of 2 ram. Basic information was comparable among the three groups before adminiatration： age, preoperative systolic blood pressure, diastolic blood pressure and heart rate were not different statistically. The dose of epinephrine-saline solution was not comparable between central airway group and terminal airway group. Observations before and after the bronehoscopy were analyzed：①Systolic blood pressure, diastolic blood pressure, heart rate （self-control） before and after the bronchoscopy.②The changes of systolic blood pressure,diastolic bloodpressure and heart rate was analyzed before and after applying of epinephrine-saline with multiple comparison.③Other related side effects were observed after instillation of epinephrine-saline solution, including palpitation, chest distress, chest pain, pallor （or flush）, headache, muscle tremor,etc. Results ①Postoperative systolic, diastolic blood pressure and heart rote were increased respectively to some degree in each group （ P 〈 0.05 or P〈 0.01）. Systolic blood pressure difference before and after administration：terminal airway group 〉 central airway group ~ control group, there was significant difference of the systolic blood pressure between terminal airway group and other groups （P 〈0.05）, there was significant difference of heart rate between terminal airway group and control group （ P〈 0.05）. There was no significant difference of other observations among the three groups. There was no difference of the diastolic blood pressure among the three groups. ③The change of blood pressure and heart rate in central airway group and terminal airway group had no correlation with epinephrine dosage （ r^2 were 0. 008 and 0.18 respectively, P 〉0.05）. ④A portion of patients appeared palpitation,angina （3 cases）, tremor, erubescence （or pallor） in the terminal airway group. Conclusions Instillation of epinephrine-saline solution into the terminal airway may result in general side effect.