右美托咪定注射液滴鼻在无痛纤维支气管镜检查中的应用研究

Study on the application of Dexmedetomidine Injection nasal drops in the examination of painless fiberoptic bronchoscopy

目的探讨右美托咪定注射液滴鼻在无痛纤维支气管镜检查中的应用。方法选择2017年1～5月在我院行择期无痛纤维支气管镜检查的80例患者作为研究对象,年龄18～75岁,ASAⅠ～Ⅲ级,将其随机分为右美托咪定滴鼻组(D组)和生理盐水对照组(C组),每组各40例。记录两组患者休息10 min后(T0)、纤维支气管镜过声门后到达隆突前(T_1)、检查结束时(T_2)的平均动脉压(MAP)及心率(HR),并比较两组患者的呛咳体动视觉模拟(VAS)综合评分、不良事件(低血压、高血压、心动过缓、心动过速)发生率、丙泊酚使用总量、苏醒时间及Ricker镇静-躁动(SAS)评分。结果两组患者T0的MAP、HR比较,差异无统计学意义(P>0.05);两组患者T_1的MAP均高于T_0,差异有统计学意义(P<0.05);C组患者T_1的HR显著高于T_0,差异有统计学意义(P<0.05);D组患者T_1的HR低于C组,差异有统计学意义(P<0.05);两组患者T_2的MAP、HR比较,差异无统计学意义(P>0.05)。D组患者的呛咳体动VAS综合评分为(4.2±1.6)分,心动过速发生率为12.5%,均分别显著低于C组的(5.6±1.8)分、22.5%,差异有统计学意义(P<0.05);两组患者的低血压、高血压、心动过缓发生率比较,差异无统计学意义(P>0.05)。D组患者的丙泊酚使用总量为(125.1±40.6)mg,显著少于C组的(138.2±31.5)mg,恢复室SAS评分为(3.9±0.5)分,显著低于C组的(4.8±0.6)分,差异有统计学意义(P<0.05);D组患者的苏醒时间为(15.2±3.9)min,与C组的(15.8±4.2)min比较,差异无统计学意义(P>0.05)。结论右美托咪定注射液滴鼻可安全有效地应用于全麻无痛纤维支气管镜检查中,相较于传统方法 ,检查过程及恢复过程更为平稳,丙泊酚用量更少,且不影响苏醒时间。

Objective To explore the application of Dexmedetomidine Injection nasal drops in the examination of painless fiberoptic bronchoscopy. Methods Eighty patients who underwent elective painless fiberoptic bronchoscopy in our hospital from January to May 2017 were enrolled in the study, whose ages were 18 to 75 years old, with ASA Ⅰ~Ⅲ. They were randomly divided into Dexmedetomidine nasal drops group (group D) and saline control group (group C), 40 cases in each group. The mean arterial pressure (MAP) and heart rate (HR) in the two groups of patients after 10 minutes of rest (T0), fiberoptic bronchoscopy after passing the glottis and before reaching the bulge (T1) and at the end of the examination (T2) were recorded. The cough and body motion visual analogue scale (VAS) comprehensive score, incidence of adverse events (hypotension, hypertension, bradycardia and tachycardia), total use of Propofol, wake time, and Ricker sedation-incitement (SAS) score were compared between the two groups. Results There were no significant differences in the MAP and HR between the two groups at T0 (P>0.05). The MAP of T1 in both groups was higher than that of T0, and the difference was statistically significant (P<0.05). The HR of T1 in group C was significantly higher than that of T0, and the difference was statistically significant (P<0.05). The HR of T1 in group D was lower than that in group C, and the difference was statistically significant (P<0.05). There were no significant differences in MAP and HR between the two groups at T2 (P>0.05). The comprehensive score of cough and body motion VAS in group D was (4.2±1.6) points, the rate of tachycardia was 12.5%, which was significantly lower than those of group C for (5.6±1.8) points and 22.5% respectively, and the differences were statistically significant (P<0.05). There were no significant differences in the incidence rates of hypotension, hypertension, and bradycardia between the two groups (P>0.05). The total amount of Propofol used in group D was (125.1±40.6) mg, which was significantly less than that in group C for (138.2±31.5) mg, the SAS score of recovery room in group D was (3.9±0.5) points, which was significantly lower than that in group C for (4.8±0.6) points, and the differences were statistically significant (P<0.05). The wake time of patients in group D was (15.2±3.9) min, compared with (15.8±4.2) min in group C, and the difference was not statistically significant (P>0.05). Conclusion Dexmedetomidine Injection nasal drops can be safely and effectively applied to in the examination of general anesthesia painless fiberoptic bronchoscopy, compared with traditional methods, the inspection process and recovery process are more stable, and the amount of Propofol is less, which does not affect the wake time.