参附注射液对老年性肺炎患者镇静下纤维支气管镜检查时血流动力学影响研究

Effect of Shenfu Injection on Hemodynamics During Sedation Bronmicroscopy in Elderly Patients with Pneumonia

目的:观察参附注射液对老年肺炎患者镇静下行纤维支气管镜(纤支镜)检查治疗时血流动力学的影响。方法:选取2019年1月至2020年10月我院急诊科老年性肺炎患者60例,分对照组和观察组各30例。两组患者行右美托咪定镇静下纤支镜检查治疗,操作时间20min。对照组全过程予生理盐水100mL静脉滴注,观察组全过程予生理盐水100mL+参附注射液40mL静脉滴注。比较两组在输注右美托咪定前(T_(0))、纤支镜到达隆突时(T_(1))、纤支镜在支气管内10min(T_(2))、检查结束时(T_(3))的心率(HR)、心率收缩压乘积(HPP)、平均动脉压(MAP)的变化;记录异常心电图发生率、血管活性药物使用率。评估缺氧和心肌缺血的程度。结果:观察组患者镇静后纤支镜检查治疗至结束各点的MAP、HR、HPP较对照组稳定。观察组内各点与术前相比,MAP、HR、HPP的波动均无统计学差异(P>0.05)。对照组内各点与术前相比,MAP、HR、HPP的波动均有统计学差异(P<0.05)。观察组异常心电图发生率、血管活性药物使用率比对照组降低(P<0.05)。结论:参附注射液用于老年性肺炎患者镇静下纤支镜检查时,可减少右美托咪定镇静时的低血压反应,减少血管活性药物使用率,减少纤支镜检查的心血管不良反应,具有稳定血流动力学和心血管保护作用。

Objective:To observe the effect of Shenfu injection on the hemodynamics of elderly patients with pneumonia undergoing sedation under bronchoscopy.Methods:From January 2019 to October 2020,60 elderly patients with pneumonia in the emergency department of our hospital were selected and divided into the control group and the observation group,30 cases in each.The two groups of patients were treated with bronchoscopy under dexmedetomidine sedation,and the operation time was 20 minutes.The control group was given 100 mL of normal saline by intravenous drip in the whole process,and the observation group was given 100 mL of normal saline+40 mL of Shenfu injection by intravenous drip in the whole process.The heart rate(HR)and the heart rate(HR)before the infusion of dexmedetomidine(T_(0)),when the bronchoscope reached the carina(T_(1)),10 minutes after the bronchoscope in the bronchus(T_(2)),and at the end of the examination(T_(3))were compared between the two groups.Changes in heart rate and systolic blood pressure product(HPP)and mean arterial pressure(MAP);abnormal electrocardiogram incidence and vasoactive drug use rate were recorded.Assess the degree of hypoxia and myocardial ischemia.Results:After sedation,the MAP,HR and HPP of patients in the observation group were more stable than those in the control group after bronchoscopy treatment to the end of the treatment.There was no significant difference in the fluctuations of MAP,HR and HPP at each point in the observation group compared with the preoperative ones(P>0.05).The fluctuations of MAP,HR and HPP at each point in the control group were significantly different from those before operation(P<0.05).The incidence of abnormal ECG and the use of vasoactive drugs in the observation g roup were lower than those in the control group(P<0.05).Conclusion:Shenfu injection can reduce the hypotensive reaction of dexmedetomidine during sedation,reduce the use rate of vasoactive drugs,and reduce the cardiovascular adverse effects of bronchoscopy in elderly patients with pneumonia.response,with stable hemodynamics and cardiovascular pr otection.