布托啡诺超前镇痛复合右美托咪啶用于老年人超声支气管镜检查
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摘要
目的评价布托啡诺超前镇痛复合右美托咪啶用于老年人超声支气管镜检查中的效果。方法拟行超声支气管镜检查患者80例,ASAⅠ~Ⅲ级,随机分为:对照组(C组)和布托啡诺组(B组),每组40例。C组患者术前10min静脉给予咪达唑仑0.05 mg/kg,芬太尼2μg/kg,并在2%利多卡因表麻下入镜。B组患者镜检前给予布托啡诺15μg/kg,右美托咪啶(Dex)0.6μg/kg,待Dex负荷量给予后靶控输注盐酸瑞芬太尼,达到靶浓度后开始入镜。分别记录给药前(T_0)、入镜前(T_1)、通过喉腔时(T_2)、通过隆突时(T_3)及镜检结束时(T_4)、镜检结束后5min(T_5)、10 min(T_6)及15 min(T7)患者平均动脉压(MBP)、心率(HR)、脉搏血氧饱和度(SpO_2)。并在T_0及T_5、T_6及T_7进行警觉/镇静(OAA/S)评分。结果与C组比较,B组患者MBP在T_2和T_3时降低,在T_2时HR降低,在T_3时SpO_2升高,镜检时间和利多卡因用量减少。镜检医师满意度评分和患者舒适度评分B组高于C组。两组患者OAA/S评分在T_5镜检结束时,B组低于C组,差异有统计学意义。结论布托啡诺超前镇痛复合右美托咪啶可以安全有效用于老年人超声支气管镜检查。
Objective To evaluate the effects of butorphanol combined with dexmedetomidine in ultrasound fiberoptic bronchoscopy for elderly patients. Methods Eighty elderly patients underwent fiberoptic bronchoscopy,were randomly divided into 2 groups:the control group(group C)and butorphanol group(B group),with 40 cases in each group. Patients in group C were given 0.05 mg/kg midazolam and 2 μg/kg fentanyl with intravenous injection and 2% lidocaine hydrochloride surface anesthesia for the ultrasound fiberoptic bronchoscopy. Patients in B group received 15 μg/kg butorphanol and 0.6 μg/kg dexmedetomidine. The mean arterial pressure(MBP),heart rate(HR),pulse oxygen saturation(SpO_2)of the patients were recorded before administration(T_0),before the fiberoptic bronchoscopy(T_1),through the laryngeal cavity(T_2),through the carina(T3)and at the end of operation(T_4),5 min(T_5),10 min(T_6),15 min(T_7)after the end of ultrasound fiberoptic bronchoscopy,respectively. The Observer's assessment of Alertness/Sedation Scale(OAA/S)was recorded at T_0 and T_5,T_6 and T_7. Results There was no significant differences in age,sex,height,weight between the two groups. Compared with the group C,the MBP of the patients in group B decreased at T_2 and T_3,the HR decreased at T_2 and SpO_2,and increased at T_3. The time of the ultrasound fiberoptic bronchoscopy for the patients in group B and the total dosage of the lidocaine hydrochloride were less than those in group C,the sedation satisfaction score of the operation physicians and the patients comfort score were better than those in group C. OAA/S score of the patients in group B was lower than that in group C. Conclusion Butorphanol combined with dexmedetomidine is a safe and effective sedation method for ultrasound fiberoptic bronchoscopy for elderly patients.
Objective To evaluate the effects of butorphanol combined with dexmedetomidine in ultrasound fiberoptic bronchoscopy for elderly patients. Methods Eighty elderly patients underwent fiberoptic bronchoscopy,were randomly divided into 2 groups:the control group(group C)and butorphanol group(B group),with 40 cases in each group. Patients in group C were given 0.05 mg/kg midazolam and 2 μg/kg fentanyl with intravenous injection and 2% lidocaine hydrochloride surface anesthesia for the ultrasound fiberoptic bronchoscopy. Patients in B group received 15 μg/kg butorphanol and 0.6 μg/kg dexmedetomidine. The mean arterial pressure(MBP),heart rate(HR),pulse oxygen saturation(SpO_2)of the patients were recorded before administration(T_0),before the fiberoptic bronchoscopy(T_1),through the laryngeal cavity(T_2),through the carina(T3)and at the end of operation(T_4),5 min(T_5),10 min(T_6),15 min(T_7)after the end of ultrasound fiberoptic bronchoscopy,respectively. The Observer's assessment of Alertness/Sedation Scale(OAA/S)was recorded at T_0 and T_5,T_6 and T_7. Results There was no significant differences in age,sex,height,weight between the two groups. Compared with the group C,the MBP of the patients in group B decreased at T_2 and T_3,the HR decreased at T_2 and SpO_2,and increased at T_3. The time of the ultrasound fiberoptic bronchoscopy for the patients in group B and the total dosage of the lidocaine hydrochloride were less than those in group C,the sedation satisfaction score of the operation physicians and the patients comfort score were better than those in group C. OAA/S score of the patients in group B was lower than that in group C. Conclusion Butorphanol combined with dexmedetomidine is a safe and effective sedation method for ultrasound fiberoptic bronchoscopy for elderly patients.
引文
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[10]KUANG Y,ZHANG R R,PEI Q,et al.Pharmacokinetic and pharmacodynamic study of dexmedetomidine in elderly patients during spinal anesthesia[J].Int J Clin Pharmacol Ther,2015,53(12):1005-1014.
[11]张隆盛,张欢楷,林耿彬,等.右美托咪定复合舒芬太尼对胸腔镜肺叶切除患者术后镇痛的影响[J/OL].实用医学杂志,2018,34(03):453-456
[12]XU L,HU Z,SHEN J,et al.Does dexmedetomidine have a cardiac protective effect during non-cardiac surgery[J]?A randomised controlled trial[J].Clin Exp Pharmacol Physiol,2014,41(11):879-883.
[13]周桥灵,赵伟成,廖美娟,等.不同剂量右美托咪定联合乌司他丁对肺叶切除术患者肺损伤的保护作用[J].实用医学杂志,2018,34(2):281-284.
[2]GOUDRA B G,SINGH P M,BORLE A,et al.Anesthesia for advanced bronchoscopic procedures:State-of-the-Art Review[J].Lung,2015,193(4):453-465.
[3]DAL T,SAZAK H,TUN?M,et al.A comparison of ketaminemidazolam and ketamine-propofol combinations used for sedation in the endobronchial ultrasound-guided transbronchial needle aspiration:a prospective,single-blind,randomized study[J].JThorac Dis,2014,6(6):742-751.
[4]YILDIRIM F,?ZKAYA?,YURDAKUL A S.Factors affecting patients.comfort during fiberoptic bronchoscopy and endobronchial ultrasound[J].J Pain Res,2017,10:775-781.
[5]SANRI E,AKOGLU E U,KARACABEY S,et al.Diagnostic utilities of tracheal ultrasound and USB-endoscope for the confirmation of endotracheal tube placement:A cadaver study[J].Am JEmerg Med,2018,pii:S0735-6757(18)30135-9.
[6]G?KTALAY T,?ELIK P,ALPAYDIN A?,et al.The Role of Endobronchial Biopsy in the Diagnosis of Pulmonary Sarcoidosis[J].Turk Thorac J,2016,17(1):22-27.
[7]梁幸甜,廖美娟,李渭敏,等.不同剂量多巴胺对瑞芬太尼联合丙泊酚行支气管镜检查患者血流动力学的影响[J].广东医学,2016,37(11):1699-1701.
[8]梁幸甜,李渭敏,廖美娟,等.丙泊酚与依托咪酯靶控输注在支气管镜麻醉效果的比较[J].实用医学杂志,2013,29(10):1600-1602.
[9]姚菊,黄赛赛.右美托咪啶复合布托啡诺在术后患者自控镇痛中的应用[J].中国现代医学杂志,2016,26(18):131-135.
[10]KUANG Y,ZHANG R R,PEI Q,et al.Pharmacokinetic and pharmacodynamic study of dexmedetomidine in elderly patients during spinal anesthesia[J].Int J Clin Pharmacol Ther,2015,53(12):1005-1014.
[11]张隆盛,张欢楷,林耿彬,等.右美托咪定复合舒芬太尼对胸腔镜肺叶切除患者术后镇痛的影响[J/OL].实用医学杂志,2018,34(03):453-456
[12]XU L,HU Z,SHEN J,et al.Does dexmedetomidine have a cardiac protective effect during non-cardiac surgery[J]?A randomised controlled trial[J].Clin Exp Pharmacol Physiol,2014,41(11):879-883.
[13]周桥灵,赵伟成,廖美娟,等.不同剂量右美托咪定联合乌司他丁对肺叶切除术患者肺损伤的保护作用[J].实用医学杂志,2018,34(2):281-284.