右美托咪定复合布托啡诺在无痛支气管镜检查中的应用效果

Effect of dexmedetomidine combined with butorphanol in painless bronchoscopy

目的探讨右美托咪定复合布托啡诺在无痛支气管镜检查中的应用效果。方法选取2021年5月-2022年5月该院呼吸与危重症医学科支气管镜室行电子支气管镜检查的144例肺结节患者作为研究对象。将144例患者分成A组(利多卡因组)、B组(利多卡因+右美托咪定组)、C组(利多卡因+右美托咪定+舒芬太尼组)和D组(利多卡因+右美托咪定+布托啡诺组),每组36例。该研究为随机对照单盲试验。全部入组患者入室后,予以鼻导管给氧,按分组实施麻醉后,完成支气管镜检查。比较各组入室时(T_(0))、麻醉诱导后5 min(T_(1))、电子支气管镜通过声门时(T_(2))、操作5 min(T_(3))、操作结束时(T_(4))和出室时(T_(5))各时点的心率(HR)、经皮动脉血氧饱和度(SpO_(2))和平均动脉压(MAP),观察并记录各组术中和术后不良反应,待患者清醒后,行患者舒适度和术者操作满意度问卷调查。结果4组患者全部完成电子支气管镜检查。4组患者T_(2)和T_(3)时点与T_(0)时点HR的差值比较,差异均有统计学意义(H值分别为21.15和19.63,P<0.05),Bonferroni检验显示,C组T_(2)和T_(3)时点与T_(0)时点HR的差值与A组和B组比较,差异均有统计学意义(P<0.05)。4组患者T_(2)时点与T_(0)时点SpO_(2)的差值比较,差异有统计学意义(H=9.58,P=0.023),Bon‐ferroni检验显示,D组T_(2)时点与T_(0)时点SpO_(2)的差值与A组比较,差异有统计学意义(P<0.05)。4组患者T_(2)和T_(3)时点与T_(0)时点MAP的差值比较,差异均有统计学意义(H值分别为9.65和21.31,P<0.05),Bonferroni检验显示,A组T_(2)时点与T_(0)时点MAP的差值及D组T_(3)时点与T_(0)时点MAP的差值与其他3组比较,差异均有统计学意义(P<0.05)。D组患者舒适度评分和术者操作满意度评分高于其他3组,差异均有统计学意义(Z值分别为62.77和53.94,P<0.01),D组不良反应发生率明显低于其他3组,差异有统计学意义(P<0.01)。结论右美托咪定复合布托啡诺麻醉方案用于无痛支气管镜检查,更能达到无痛苦效果,血流动力学更平稳,不易发生呼吸抑制,患者舒适度及术者操作满意度更高,不良反应较少,值得临床推广应用。

Objective To investigate the effect of dexmedetomidine combined with butorphanol in painless bronchoscopy.Methods 144 patients with pulmonary nodules who underwent electronic bronchoscopy from May 2021 to May 2022 were selected as the research subjects.144 patients were divided into group A(lidocaine group),group B(lidocain+dexmedetomidine group),group C(lidocaine+dexmedetomidine+sufentanil combination group)and D group(lidocaine+dexmedetomidine+butorphanol combination group),36 cases in each group by randomized controlled single-blind trial.All the enrolled patients were given oxygen by nasal cannula after entering the room.The bronchoscopy was completed after anesthesia according to groups.Entering the room(T_(0)),5 min after induction of anesthesia(T_(1)),when the electronic bronchoscope passed through the glottis(T_(2)),5 min after the operation(T_(3)),at the end of the operation(T_(4)),and leaving the room(T_(5))in each group were compared.Heart rate(HR),percutaneous arterial oxygen saturation(SpO_(2)),mean arterial pressure(MAP),intraoperative and postoperative adverse reactions in each group were observed and recorded,and the questionnaire was used to assess the patients’comfort and operator’s satisfaction after patients woken up.Results All the patients in the 4 groups completed electronic bronchoscopy.The difference of HR differences between T_(2),T_(3)and T_(0)was statistically significant(H values were 21.15 and 19.63,both P<0.05),Bonferroni test showed that the difference of HR differences at T_(2),T_(3)and T_(0)in group C was statistically significant compared with Group A or Group B(all P<0.05).The difference of SpO_(2)differences between T_(2)and T_(0)in four groups was statistically significant(H=9.58,P=0.023).Bonferroni test showed that the difference of SpO_(2)differences between T_(2)and T_(0)in group D was higher than that in group A,the difference was statistically significant(P<0.05).The difference of MAP differences between T_(2),T_(3)and T_(0)was statistically significant(H values were 9.65 and 21.31,both P<0.05).Bonferroni test showed that the difference of MAP differences between T_(2)and T_(0)in group A and T_(3)and T_(0)in group D were significantly different from those of the other three groups,the differences were statistically significant(P<0.05).Comparing each group,the patient comfort scale and the operator satisfaction scale in group D were higher than those in other groups,and the differences were statistically significant(Z values were 62.77 and 53.94,both P<0.01),and group D had significantly lower adverse reactions than those in other groups,the difference was statistically significant(P<0.01).Conclusion Dexmedetomidine combined with butorphanol anesthesia can be more pain-free effect,relatively more stable hemodynamics,lower probability of respiratory depression,higher patient comfort and operator satisfaction,and fewer adverse reactions.It is worth promoting and applying.