阿托品在老年患者全麻气管插管行超声支气管镜引导下经支气管针吸活检术前的应用价值

The application value of atropine before tracheal intubation under general anesthesia in elderly patients undergoing endobronchial ultrasound-guided transbronchial needle aspiration biopsy

目的探讨术前应用阿托品对老年患者进行全麻气管插管超声支气管镜引导下经支气管针吸活检(EBUS-TBNA)的价值。方法病例对照研究,纳入胸部增强CT倾向肺癌伴7区纵隔淋巴结增大并拟行全麻气管插管支气管镜活检及EBUS-TBNA检查的87例老年住院患者。采用掷硬币法随机分为阿托品组40例和对照组47例。评估术前、术中及术后患者收缩压、舒张压、心率、口咽气道分泌物量、指端血氧饱和度、操作时间、病理阳性率及术后不良反应情况,评价阿托品应用价值。结果气管插管术前阿托品组收缩压、舒张压低于对照组(131.70±15.3)mmHg比(140.7±13.7)mmHg、(79.1±7.6)mmHg比(85.6±7.4)mmHg(t值2.885、4.061,均P<0.05)。内镜操作开始后10 min阿托品组和对照组收缩压(109.1±11.2)mmHg比(105.0±12.15)mmHg、舒张压(66.9±7.5)mmHg比(68.0±8.3)mmHg;拔除气管插管后10 min为(136.9±23.0)mmHg比(129.9±11.2)mmHg、(77.6±10.9)mmHg比(78.5±6.4)mmHg(t值分别为-1.617、0.687、-1.751、0.448,均P>0.05)。气管插管术前阿托品组和对照组心率差异无统计学意义(t=1.416,P>0.05),内镜操作开始后10 min和拔除气管插管后10 min阿托品组高于对照组,差异有统计学意义(t值-3.323、-2.181,P<0.01和P<0.05)。内镜操作开始后10 min、拔除气管插管后10 min阿托品组患者收缩压、舒张压变化率均小于对照组(t值-7.947、-6.962、-3.187、-3.232,均P<0.01)。内镜操作开始后10 min阿托品组心率变化率小于对照组,拔除气管插管后10 min变化率大于对照组(t值-6.467、-4.131,均P<0.01)。阿托品组和对照组气管插管术前与拔除气管插管后10 min口咽及气道分泌物、指端血氧饱和度比较差异有统计学意义(t值分别为-2.334、2.759、-3.314、-2.767,均P<0.01)。阿托品组内镜操作时间(25.9±5.7)min较对照组(26.4±4.7)min短(t=0.391,P>0.05)。阿托品组术后无不良反应患者34例(85.0%),对照组43例(91.5%),差异无统计学意义(χ^(2)=1.247,P>0.05)。结论老年患者全麻气管插管EBUS-TBNA术前应用阿托品有利于稳定术中血压和心率,且减少术后口咽、气道分泌物产生。

Objective To investigate the value of atropine administration before tracheal intubation under general anesthesia in the elderly patients undergoing endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)biopsy.Methods This was a case-control study.A total of 87 elderly hospitalized patients receiving chest enhanced CT test suggesting the risk of lung cancer with enlargement of mediastinal lymph nodes in 7 regions were scheduled to undergo endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)biopsy under general anesthesia.The patients were randomly divided into two groups by flipping a coin:the atropine group(n=40)and the control group(n=47).The indicators for evaluating the application values of atropine included preoperative,intra-operative and postoperative systolic blood pressure(SBP),diastolic blood pressure(DBP),heart rate,oropharyngeal and airway secretion volume,oxygen saturation,operation time,positive diagnosis rate and postoperative adverse reactions.Results SBP and DBP were lower in the atropine group than in the control group before endotracheal intubation(131.7±15.3 mmHg vs.140.7±13.7 mmHg,79.1±7.6 mmHg vs.85.6±7.4 mmHg,t=2.885 and 4.061,P<0.05).There was no significant difference in SBP and DBP 10 min after endoscopic operation and 10 min after tracheal extubation between the atropine group versus the control group(SBP:109.1±11.2 mmHg vs.105.0±12.2 mmHg,136.9±23.0 mmHg vs.129.9±11.2 mmHg,DBP:66.9±7.5 mmHg vs.68.0±8.3 mmHg,77.6±10.9 mmHg vs.78.5±6.4 mmHg,t=-1.617,0.687,-1.751 and 0.448,P>0.05).There was no significant difference in HR between the two groups before endotracheal intubation(t=1.416,P>0.05),while HR was higher in the atropine group than in the control group 10 min after endoscopic operation and 10 min after tracheal extubation(t=-3.323 and-2.181,P<0.01 and P<0.05).The change rates of SBP and DBP were lower in the atropine group than in the control group 10 min after endoscopic operation and 10 min after tracheal extubation(t=7.947,-6.962,-3.187 and-3.232,P<0.01).The change rate of HR was lower in the atropine group 10 min after endoscopic operation and was higher 10 min after tracheal extubation than in the control group(t=-6.467 and-4.131,P<0.01).There were significant differences in the volume of oropharyngeal and airway secretions and fingertip oxygen saturation between the two groups before endotracheal intubation and 10 min after tracheal extubation(t=-2.334,2.759,-3.314 and-2.767,P<0.01).The endoscopic operation time was less in the atropine group than in the control group with no statistically significant difference[(25.9±5.7)min vs.(26.4±4.7)min,t=0.391,P>0.05].There was no significant difference in postoperative adverse reactions between the atropine group versus the control group(34 patients or 85.0%vs.43 patients or 91.5%,χ^(2)=1.247,P>0.05).Conclusions The application of atropine before tracheal intubation under general anesthesia is beneficial to stabilizing the intraoperative blood pressure and heart rate,and can reduce the production of postoperative oropharyngeal and airway secretions in elderly patients undergoing endobronchial ultrasound-guided transbronchial needle aspiration biopsy.