纤维支气管镜检查中右美托咪定清醒镇静的护理及其效果

Nursing and effective assessment of Dexmedetomidine conscious sedation in the fiber bronchoscope examination

目的评价右美托咪定用于纤维支气管镜（FB）检查患者清醒镇静治疗的护理及使用效果,以提高FB检查中患者舒适度。方法选择2011年10月~2013年12月在浙江省丽水市中心医院行FB检查的126例患者,分为A、B两组。A组采用高氧驱动以7 L/min的速度用面罩雾化吸入2%利多卡因5 mL行表面麻醉＋环甲膜穿刺局部麻醉。B组将右美托咪定针按0.6μg/kg标准在10 min内用微量注射泵匀速输完全,同时复合高氧驱动雾化吸入2%利多卡因5 mL表面麻醉。并将两组患者在检查中的平均动脉压（MAP）、心率（HR）、血氧饱和度（SPO2）等在入室未使用药物前（T1）、FB检查前（T2）、FB插入声门时（T3）、插入支气管后（T4）、检查结束时（T5）5个时间点进行监测,评定麻醉效果,记录检查期间的不良反应等并进行对比分析。结果两组患者在性别、年龄、体重、美国麻醉医师协会（ASA）分级上比较差异无统计学意义（P〉0.05）。A组患者检查期自T2时间点起MAP、HR监测数据开始逐步升高,不良反应增加。B组MAP、HR稍有变化,与A组比较差异有统计学意义（P〈0.05）。B组患者所需的检查时间显著缩短,患者的舒适度增加,护理工作任务减轻,麻醉效果的优良率高于A组,经统计学比较,差异有统计学意义（P〈0.05）。A组患者不良反应发生率为60.31%,B组不良反应发生率为12.70%,两组不良反应发生率比较,差异有统计学意义（P〈0.05）。结论在有效、合理、规范化护理保障下,高氧驱动2%利多卡因吸入表面麻醉复合右美托咪定行静脉慢诱导清醒镇静联合麻醉,不仅能使FB检查得以顺利进行,而且能减轻患者的痛苦,减少不良事件的发生。

Objective To evaluate the nursing and effects of Dexmedetomidine conscious sedation therapy in fiberoptic bronchoscopy （FB）, in order to improve the patients＇ comfort level in FB examination. Methods 126 eases of patients were selected, all of whom were under gone FB examination from October 2011 to December 2013. The patients were divided into group A and group B. Group A was given 5 mL of 2% Lidocaine by mask aerosol inhalation at speed of 7 L/min driven by high oxygen for surface anesthesia and given thyrocricocentesis for local anesthesia. Group B was given Dexmedetomidine （DEX） by trace injection pump at 0.6 txg/kg, which should be uniformly infused within 10 min- utes, and given 5 mL of 2% Lidocaine by aerosol inhalation driven by high oxygen for surface anesthesia. The two groups of patients were monitored at 5 equal time points of home before the use of drugs （TI）, FB （T2）, insert the glottis FB before check （T3）, insert after bronchial （T4）, at the end of the inspection （Ts） for MAP, HR, and SPO2, etc.. The anesthesia effect was evaluated and data such as adverse reactions during the examination was recorded, and the data were compared and analyzed. Results Two groups of patients were compared in gender, age, weight and grade of ASA, and there were no significant differences （P 〉 0.05）. For patients of group A, MAP and HR monitoring data began to rise gradually from time point T2 during the examination period, and the adverse reaction increased. Compared with group A, the changes of MAP and HR in group B were of statistically significant difference （P 〈 0.05）. Compared with group A, the group B was fortable level the excellent examination time required for patients in significantly shortened, the patients＇ corn- increased, the nursing work reduced and and good rate of anesthesia effect was higher, and there were significant differences （P 〈 0.05）. The incidence of adverse reations in group A of patients was 60.31%, and was 12.70% in group B, there was statistically significant difference （P 〈 0.05）. Conclusion Under the ef- fective, reasonable and standardized nursing security, conscious sedation combined with anesthesia by intravenous slow induction of Dexmedetomidine and by inhalation surface anesthesia of 2% Lidocaine driven by high oxygen, can not only make the FB examination smoothly but also reduce the patients＇ suffering and the occurrence of adverse events.