纳布啡联合右美托咪定在无痛超声支气管镜中的应用

陈念平; 周海燕; 仇元利; 宋铖; 朱雅芳; 徐亮

doi:10.16766/j.cnki.issn.1674-4152.002763

纳布啡联合右美托咪定在无痛超声支气管镜中的应用

doi: 10.16766/j.cnki.issn.1674-4152.002763

1.
绍兴文理学院附属医院麻醉科，浙江绍兴 312000
2.
绍兴文理学院附属医院内镜中心，浙江绍兴 312000
3.
绍兴文理学院附属医院呼吸内科，浙江绍兴 312000

基金项目:

浙江省医药卫生科技计划项目 2020KY988

详细信息

通讯作者:
陈念平, E-mail: sxcnp@126.com

中图分类号: R614.24 R655.3
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- 被引次数: 0
出版历程
- 收稿日期: 2021-11-25
- 网络出版日期: 2023-02-07

Application of nalbuphine combined with dexmedetomidine in painless ultrasound bronchoscopy

1.
Department of Anesthesiology, Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang 312000, China

摘要

摘要: 目的探讨纳布啡或舒芬太尼联合右美托咪定在无痛超声支气管镜检查中对血流动力学、呼吸频率及疼痛评分等相关指标的影响。方法选择2019年12月—2021年10月在绍兴文理学院附属医院拟行无痛超声支气管镜检查的患者50例，采用随机数字表法随机分为舒芬太尼联合右美托咪定组(SD组)和纳布啡联合右美托咪定组(ND组)，每组各25例。2组患者在利多卡因表面麻醉的基础上，经静脉泵注右美托咪定1 μg/kg(15 min泵注完毕)后，ND组经静脉给予纳布啡0.1 mg/kg，SD组经静脉给予舒芬太尼0.1 μg/kg，随后2组均使用丙泊酚维持麻醉。监测用药前、纤维支气管镜进入声门时、穿刺活检时、检查结束时的血压、心率、脉搏氧饱和度及呼吸频率变化；观察并记录2组患者检查期间丙泊酚用量、操作时间、苏醒时间、检查过程中麻醉效果分级及用药后不良反应发生情况；评估并记录患者术前和术后1、2、4、6 h VAS评分。结果 ND组支气管镜检查期间血压、心率、脉搏氧饱和度及呼吸频率变化低于SD组(均P < 0.05)；2组患者丙泊酚用量[(210.4±30.3)mg vs. (232.2±58.5)mg]、操作时间[(28.9±9.4)min vs.(30.1±8.8)min]、苏醒时间[(8.3±2.2)min vs.(9.1±3.1)min]及麻醉效果优良率(96.0% vs. 72.0%)比较差异无统计学意义(均P>0.05)；ND组术后VAS评分及不良反应发生率明显低于SD组(均P < 0.05)。结论纳布啡联合右美托咪定用于无痛超声支气管镜检查血流动力学稳定，不良反应少，是舒芬太尼安全有效的替代药物之一。
- 麻醉 /
- 纳布啡 /
- 超声 /
- 右美托咪定 /
- 支气管镜
Abstract: Objective To investigate the influence of nalbuphine or sufentanil combined with dexmedetomidine on hemodynamics, respiratory rate and pain score in painless ultrasonic bronchoscopy. Methods Fifty patients planned to undergo painless ultrasound bronchoscopy in Affiliated Hospital of Shaoxing University from December 2019 to October 2021 were randomly divided into sufentanil combined with dexmedetomidine group (SD group) and nalbuphine combined with dexmedetomidine (ND group), 25 patients in each group. On the basis of topical anesthesia with lidocaine, the patients in the two groups were injected with dexmedetomidine 1 μg/kg (15 min) intravenously. The patients in the ND group were intravenously injected with nalbuphine 0.1 mg/kg and patients in the SD group were given sufentanil 0.1 μg/kg intravenously, then propofol was used to maintain anesthesia in both groups. The changes of blood pressure, heart rate, pulse oxygen saturation and respiratory rate were monitored before medication, at fibrobronchoscope entered glottis, biopsy and the end of examination. The amount of propofol, operation time, recovery time, anesthesia effect classification during the examination and the occurrence of adverse reactions after administration were observed and recorded. The VAS score before operation, 1 hour, 2 hours, 4 hours and 6 hours after operation were also evaluated and recorded. Results The changes in blood pressure, heart rate, pulse oxygen saturation and respiratory rate during bronchoscopy in the ND group were lower than those in the SD group (all P < 0.05). There was no significant difference in the dosage of propofol [(210.4±30.3) mg vs. (232.2±58.5) mg], operation time [(28.9±9.4) min vs. (30.1±8.8) min], recovery time [(8.3±2.2) min vs. (9.1±3.1) min] and excellent rate of anesthesia effect (96.0% vs. 72.0%) between the two groups (all P>0.05). The postoperative VAS score and the incidence of adverse reactions in the ND group were significantly lower than those in the SD group (all P < 0.05). Conclusion Nalbuphine combined with dexmedetomidine used in painless ultrasound bronchoscopy has stable hemodynamics and few adverse reactions. It is one of the safe and effective substitutes for sufentanil.
- Anaesthesia /
- Nalbuphine /
- Ultrasound /
- Dexmedetomidine /
- Bronchoscopy

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表 1 2组超声支气管镜检查患者年龄、性别、身高、体重等一般资料比较

Table 1. Comparison of age, gender, height, weight and other general conditions between the two groups examined by ultrasound bronchoscopy

组别	例数	性别(男/女，例)	年龄(x±s，岁)	身高(x±s，cm)	体重(x±s，kg)
SD组	25	12/13	51.4±10.3	165.3±10.7	52.7±11.5
ND组	25	14/11	50.2±12.1	163.5±11.9	51.2±12.8
统计量		0.320^a	0.375^b	0.561^b	0.422^b
P值		0.571	0.709	0.578	0.675
注：^a为χ²值，^b为t值。

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表 2 2组超声支气管镜检查患者各时间点血压、心率、呼吸频率及氧饱和度变化情况比较(x±s)

Table 2. Comparison of blood pressure, heart rate, respiratory rate and oxygen saturation at different time between the two groups examined by ultrasound bronchoscopy(x±s)

组别	例数	SPO₂(%)				RR(次/min)
组别	例数	T0	T1	T2	T3	T0	T1	T2	T3
SD组	25	95.9±3.2	92.6±4.6^a	93.5±2.7^a	95.4±2.3^b	18.3±3.0	15.4±2.6^a	10.2±3.3^ab	10.5±1.8^ab
ND组	25	95.8±3.9	94.8±2.4	95.3±2.7	96.2±2.5	17.8±2.7	15.0±2.4^a	12.9±3.3^ab	13.5±2.1^ab
t值		0.099	2.120	2.357	1.177	0.619	0.565	2.893	5.423
P值		0.921	0.041	0.023	0.245	0.539	0.575	0.006	< 0.001

组别	例数	MAP(mm Hg)				HR(次/min)
组别	例数	T0	T1	T2	T3	T0	T1	T2	T3
SD组	25	96.8±25.3	85.8±27.0	71.3±11.4^ab	68.9±10.1^ab	66.0±12.2	90.3±9.1^a	85.3±10.7^a	70.4±8.7^bc
ND组	25	97.5±26.3	88.5±22.5	78.5±10.7^a	75.0±11.3^ab	64.2±11.1	72.5±10.5^a	70.6±8.5^a	65.1±11.6^b
t值		0.096	0.384	2.303	2.012	0.546	6.405	5.379	1.828
P值		0.924	0.703	0.026	0.050	0.588	< 0.001	< 0.001	0.074
注：与同组T0比较，^aP＜0.05；与同组T1比较，^bP＜0.05；与同组T2比较，^cP＜0.05。1 mm Hg=0.133 kPa。

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表 3 2组超声支气管镜检查患者丙泊酚用量、苏醒时间及操作时间比较(x±s)

Table 3. Comparison of propofol dosage, recovery time and operation time between the two groups examined by ultrasound bronchoscopy(x±s)

组别	例数	丙泊酚用量(mg)	苏醒时间(min)	操作时间(min)
SD组	25	232.2±58.5	9.1±3.1	30.1±8.8
ND组	25	210.4±30.3	8.3±2.2	28.9±9.4
t值		1.654	1.052	0.466
P值		0.107	0.298	0.643

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表 4 2组超声支气管镜检查患者麻醉效果分级情况比较

Table 4. Comparison of anesthesia effect grades between the two groups examined by ultrasound bronchoscopy

组别	例数	优(例)	良(例)	差(例)	优良率(%)
SD组	25	5	13	7	72.0
ND组	25	10	14	1	96.0
注：2组麻醉效果优良率比较，χ²=3.720，P=0.054。

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表 5 2组超声支气管镜检查患者用药后不良反应比较[例(%)]

Table 5. Comparison of adverse reactions after medication between the two groups examined by ultrasound bronchoscopy[cases(%)]

组别	例数	呼吸抑制	眩晕	恶心呕吐	呛咳反应
SD组	25	9(36.0)	4(10.0)	2(8.0)	14(56.0)
ND组	25	2(8.0)	2(8.0)	3(12.0)	6(24.0)
χ²组		4.195	0.189	< 0.001	5.333
P值		0.040	0.663	0.999	0.020

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表 6 2组超声支气管镜检查患者术后各时间点VAS评分比较(x±s，分)

Table 6. Comparison of VAS scores at different time after operation between the two groups examined by ultrasound bronchoscopy(x±s, points)

组别	例数	术前	术后1 h	术后2 h	术后4 h	术后6 h
SD组	25	1.10±0.43	2.30±0.65^a	3.20±0.91^ab	3.52±0.74^ab	3.66±0.62^abc
ND组	25	1.15±0.35	1.60±0.44^a	1.78±0.52^a	2.10±0.36^abc	2.30±0.57^abc
t值		0.451	4.459	6.774	8.628	8.074
P值		0.654	< 0.001	< 0.001	< 0.001	< 0.001
注：与同组术前比较，^aP＜0.05；与同组术后1 h比较，^bP＜0.01；与同组术后2 h比较，^cP＜0.05。

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