雾化超微粒径戊乙奎醚在支气管镜针吸活检中减少气道痉挛样变的临床研究

Application of atomized penehyclidine in ultrafine particle size for reducing airway spasmodic changes in transbronchial nee⁃dle aspiration

目的评价雾化超微粒径戊乙奎醚用于喉罩全麻患者支气管镜针吸活检(transbronchial needle aspiration,TBNA)术中的效果。方法选择行TBNA术患者,年龄44~78岁,ASA分级Ⅱ级或Ⅲ级,采用随机数字表法分为雾化超微粒径戊乙奎醚组(AP组)和雾化生理盐水组(AS组),每组25例。全麻喉罩通气下行TBNA术,术前AP组患者雾化超微粒径戊乙奎醚1 mg,AS组采用等量生理盐水代替。记录患者苏醒期分泌物重量和肺部气道痉挛样变发生情况,记录进镜时(T_(1))、最后1针穿刺时(T_(2))、退镜时(T_(3))的心率、SpO_(2)、MAP、气道峰值压力(peak pressure,Ppeak)和平台压(plateau pressure,Pplat),记录麻醉时间、手术时间及口干/面红、尿潴留、术后谵妄等不良反应发生情况。结果两组患者性别、年龄、ASA分级、手术时间、麻醉时间差异无统计学意义(P>0.05)。与AS组比较,AP组患者肺部气道痉挛样变发生率低(P<0.05),苏醒期分泌物重量明显较少(P<0.05)。两组患者T_(1)~T_(3)时MAP、心率、SpO_(2)与T_(1)、T_(3)时Ppeak和Pplat差异均无统计学意义(P>0.05),AP组患者T2时Ppeak和Pplat明显低于AS组(P<0.05);T2时两组患者Ppeak均高于T1、T3时(P<0.05)。两组患者口干/面红、尿潴留、术后谵妄等不良反应差异无统计学意义(P>0.05)。结论全麻TBNA术中,雾化超微粒径戊乙奎醚能够减少患者苏醒期呼吸道分泌物,降低气道痉挛样变发生率。

Objective To evaluate the effect of atomized penehyclidine in ultrafine particle size on patients undergoing trans‑bronchial needle aspiration(TBNA)under laryngeal mask anesthesia.Methods Patients,aged 44‒78 years,American Society of Anesthesiologists(ASA)ⅡorⅢ,who underwent TBNA,were selected.According to the random number table method,they were di‑vided into two groups(n=25):an atomized penehyclidine in ultrafine particle size group(group AP)and an atomized normal saline group(group AS).TBNA was performed under general anesthesia with laryngeal mask ventilation.Before surgery,atomized penehycli‑dine in ultrafine particle size was inhaled at 1 mg in group AP,while the same amount of normal saline was inhaled in group AS.Then,the secretion weight during the recovery period and pulmonary airway spasmodic changes were recorded.Furthermore,heart rate,pulse oxygen saturation(SpO_(2)),mean arterial pressure(MAP),peak pressure(Ppeak)and plateau pressure(Pplat)were recorded at the inser‑tion of the endoscope(T_(1)),at the puncture of the final needle(T_(2))and during withdrawal of the endoscope(T_(3)).The duration of anesthe‑sia,duration of operation,and dry mouth/flush,urinary retention,and postoperative delirium were recorded.Results There were no statistical differences in sex,age,ASA grade,duration of operation,duration of anesthesia between the two groups(P>0.05).Compared with group AS,group AP showed decreases in the incidence of pulmonary airway spasmodic changes(P<0.05)and the amount of secre‑tion during recovery(P<0.05).There were no statistical differences in MAP,heart rate and SpO2 at T_(1),T_(2) and T_(3),as well as Ppeak and Pplat at T_(1) and T_(3) between the two groups(P>0.05).Compared with group AS,group AP presented remarkably reduced Ppeak and Pplat at T_(2)(P<0.05).Ppeak in T2 was higher than that in T_(1) and T_(3) in both groups(P<0.05).There was no statistical difference in dry mouth/red face,urine retention,and postoperative delirium between the two groups(P>0.05).Conclusions During TBNA under general anesthesia,atomized penehyclidine in ultrafine particle size can reduce respiratory secretion during the recovery period and re‑duce the incidence of airway spasmodic changes.