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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

陈念平, 周海燕, 仇元利, 宋铖, 朱雅芳, 徐亮. 纳布啡联合右美托咪定在无痛超声支气管镜中的应用[J]. 中华全科医学, 2022, 20(12): 2034-2037. doi: 10.16766/j.cnki.issn.1674-4152.002763
引用本文: 陈念平, 周海燕, 仇元利, 宋铖, 朱雅芳, 徐亮. 纳布啡联合右美托咪定在无痛超声支气管镜中的应用[J]. 中华全科医学, 2022, 20(12): 2034-2037. doi: 10.16766/j.cnki.issn.1674-4152.002763
CHEN Nian-ping, HOU Hai-yan, QIU Yuan-li, SONG Cheng, ZHU Ya-fang, XU Liang. Application of nalbuphine combined with dexmedetomidine in painless ultrasound bronchoscopy[J]. Chinese Journal of General Practice, 2022, 20(12): 2034-2037. doi: 10.16766/j.cnki.issn.1674-4152.002763
Citation: CHEN Nian-ping, HOU Hai-yan, QIU Yuan-li, SONG Cheng, ZHU Ya-fang, XU Liang. Application of nalbuphine combined with dexmedetomidine in painless ultrasound bronchoscopy[J]. Chinese Journal of General Practice, 2022, 20(12): 2034-2037. 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
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

Application of nalbuphine combined with dexmedetomidine in painless ultrasound bronchoscopy

  • 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。

     

  • 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 0.320a 0.375b 0.561b 0.422b
    P 0.571 0.709 0.578 0.675
    注:a为χ2值,bt值。
    下载: 导出CSV

    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)
    T0 T1 T2 T3 T0 T1 T2 T3
    SD组 25 95.9±3.2 92.6±4.6a 93.5±2.7a 95.4±2.3b 18.3±3.0 15.4±2.6a 10.2±3.3ab 10.5±1.8ab
    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±2.4a 12.9±3.3ab 13.5±2.1ab
    t 0.099 2.120 2.357 1.177 0.619 0.565 2.893 5.423
    P 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)
    T0 T1 T2 T3 T0 T1 T2 T3
    SD组 25 96.8±25.3 85.8±27.0 71.3±11.4ab 68.9±10.1ab 66.0±12.2 90.3±9.1a 85.3±10.7a 70.4±8.7bc
    ND组 25 97.5±26.3 88.5±22.5 78.5±10.7a 75.0±11.3ab 64.2±11.1 72.5±10.5a 70.6±8.5a 65.1±11.6b
    t 0.096 0.384 2.303 2.012 0.546 6.405 5.379 1.828
    P 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。
    下载: 导出CSV

    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 1.654 1.052 0.466
    P 0.107 0.298 0.643
    下载: 导出CSV

    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。
    下载: 导出CSV

    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 4.195 0.189 < 0.001 5.333
    P 0.040 0.663 0.999 0.020
    下载: 导出CSV

    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±0.65a 3.20±0.91ab 3.52±0.74ab 3.66±0.62abc
    ND组 25 1.15±0.35 1.60±0.44a 1.78±0.52a 2.10±0.36abc 2.30±0.57abc
    t 0.451 4.459 6.774 8.628 8.074
    P 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。
    下载: 导出CSV
  • [1] 徐泾, 张玉涛. 改良麻醉方式在气管镜检查中的应用[J]. 临床医学研究与实践, 2017, 2(6): 77-78. https://www.cnki.com.cn/Article/CJFDTOTAL-YLYS201706039.htm

    XU J, ZHANG Y T. Application of the modified anesthesia on bronchoscope examination[J]. Clinical Research and Practice, 2017, 2(6): 77-78. https://www.cnki.com.cn/Article/CJFDTOTAL-YLYS201706039.htm
    [2] 朱涛, 陈玲阳. 右美托咪定用于烧伤伴高血压患者削痂植皮术中的镇静效果分析[J]. 中华全科医学, 2019, 17(3): 388-391, 454. doi: 10.16766/j.cnki.issn.1674-4152.000688

    ZHU T, CHEN L Y. Efficacy of Dexmedetomidine for sedation in tangential excision and skin grafting for burn injury[J]. Chinese Journal of General Practice, 2019, 17(3): 388-391, 454. doi: 10.16766/j.cnki.issn.1674-4152.000688
    [3] 吕江军, 俞丽君, 吕小玲. 单肺通气期间输注右美托咪定对胸腔镜下老年肺部手术患者氧合和呼吸力学的影响[J]. 中华全科医学, 2019, 17(9): 1524-1526, 1570. doi: 10.16766/j.cnki.issn.1674-4152.000987

    LV J J, YU L J, LV X L. Effects of dexmedetomidine infusion during one-lung ventilation on oxygenation and respiratory mechanics in elderly patients undergoing thoracoscopic lung surgery[J]. Chinese Journal of General Practice, 2019, 17(9): 1524-1526, 1570. doi: 10.16766/j.cnki.issn.1674-4152.000987
    [4] GAO Y, KANG K, LIU H T, et al. Effect of dexmedetomidine and midazolam for flexible fiberoptic bronchoscopy in intensive care unit patients: A retrospective study[J]. Medicine (Baltimore), 2017, 96(25): e7090. DOI: 10.1097/MD.0000000000007090.
    [5] 刘韶华, 万有栋, 罗永刚, 等. 纳布啡用于ICU患者镇痛的有效性和安全性[J]. 中华危重病急救医学, 2018, 30(5): 471-476. doi: 10.3760/cma.j.issn.2095-4352.2018.05.015

    LIU S H, WAN Y D, LUO Y G, et al. Efficacy and safety of nalbuphine on analgesia of patients in intensive care unit[J]Chinese Critical Care Medicine, 2018, 30(5): 471-476. doi: 10.3760/cma.j.issn.2095-4352.2018.05.015
    [6] JEGER V, ARRIGO M, HILDENBRAND F F, et al. Improving animal welfare using continuous nalbuphine infusion in a long-term rat model of sepsis[J]. Intensive Care Med Exp, 2017, 5(1): 23. doi: 10.1186/s40635-017-0137-2
    [7] 郭鹏, 王军. 纳布啡的特点及在小儿麻醉中的应用[J]. 国际麻醉学与复苏杂志, 2020, 41(1): 63-64, 66. doi: 10.3760/cma.j.issn.1673-4378.2020.01.014

    GUO P, WANG J. Characteristics of nalbuphine and its application in pediatric anesthesia[J]. International Journal of Anesthesiology and Resuscitation, 2020, 41(1): 63-64, 66. doi: 10.3760/cma.j.issn.1673-4378.2020.01.014
    [8] MATHAI F, PORTUGAL F, MEHTA Z, et al. Nalbuphine #381[J]. J Palliat Med, 2019, 22(11): 1471-1472. doi: 10.1089/jpm.2019.0482
    [9] DENG C Y, WANG X, ZHU Q M, et al. Comparison of nalbuphine and sufentanil for colonoscopy: A randomized controlled trial[J]. PLoS One, 2017, 12(12): e0188901. DOI: 10.1371/journal.pone.0188901.
    [10] 滕云娟, 赵君, 吴慧红. 纳布啡预防舒芬太尼全身麻醉诱导引发咳嗽的效果分析[J]. 重庆医学, 2020, 49(3): 439-442. doi: 10.3969/j.issn.1671-8348.2020.03.022

    TENG Y J, ZHAO J, WU H H. Analysis on effect of nabulphine for prevention of cough induced by sufentanyl general anaesthesia[J]. Chongqing Medicine, 2020, 49(3): 439-442. doi: 10.3969/j.issn.1671-8348.2020.03.022
    [11] WANG J, DUAN J J, XIE C Y, et al. Comparison between intravenous nalbuphine and lidocaine in reducing propofol-induced injection pain during gastroscopy: A randomized controlled trial[J]. Pain Ther, 2020, 9(2): 563-571. doi: 10.1007/s40122-020-00188-y
    [12] CHEN L M, ZHOU Y M, CAI Y Y, et al. The ED95 of nalbuphine in outpatient-induced abortion compared to equivalent sufentanil[J]. BCPT, 2018, 123(2): 202-206.
    [13] 何玲, 李秀泽, 李军, 等. 两种药物的术后镇痛效果比较及对血清SOD、CAT、外周血免疫细胞水平的影响[J]. 国际检验医学杂志, 2021, 42(2): 151-154, 160. https://www.cnki.com.cn/Article/CJFDTOTAL-GWSQ202102007.htm

    HE L, LI X Z, LI J, et al. Comparison of postoperative analgesic effect between two drugs and their effects on serum SOD, CAT and peripheral blood immune cells levels[J]. International Journal of Laboratory Medicine, 2021, 42(2): 151-154, 160. https://www.cnki.com.cn/Article/CJFDTOTAL-GWSQ202102007.htm
    [14] XI M Y, LI S S, ZHANG C, et al. Nalbuphine for analgesia after orthognathic surgery and its effect on postoperative inflammatory and oxidative stress: A randomized double-blind controlled trial[J]. J Oral Maxillofac Surg, 2020, 78(4): 528-537.
    [15] 卢月霞, 蔡亲峰. 纳布啡复合丙泊酚麻醉在老年患者无痛胃镜检查中的应用及对患者认知功能的影响[J]. 中国内镜杂志, 2021, 27(7): 20-25. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGNJ202107004.htm

    LU Y X, CAI Q F. Application of Nalbuphine combined with Propofol anesthesia in elderly patients undergoing painless gastroscopy and its influence on cognitive function[J]. China Journal of Endoscopy, 2021, 27(7): 20-25. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGNJ202107004.htm
    [16] 余盼, 邹岩, 王军. 纳布啡在围手术期的应用[J]. 国际麻醉学与复苏杂志, 2021, 42(9): 983-986.

    YU P, ZOU Y, WANG J. Application of nalbuphine in perioperative period[J]International Journal of Anesthesiology and Resuscitation, 2021, 42(9): 983-986.
    [17] 彭丽佳, 杨渊, 郭然, 等. 右美托嘧啶联合纳布啡用于脑膜瘤手术对患者术后认知功能的影响[J]. 昆明医科大学学报, 2021, 42(3): 18-22. https://www.cnki.com.cn/Article/CJFDTOTAL-KMYX202103004.htm

    PENG L J, YANG Y, GUO R, et al. Effect of Dexmedetomidine Combined with Nalbuphine in Meningioma Surgery on Postoperative Cognitive Function[J]. Journal of Kunming Medical University, 2021, 42(3): 18-22. https://www.cnki.com.cn/Article/CJFDTOTAL-KMYX202103004.htm
    [18] 程艳欣, 常和平, 张健, 等. 盐酸纳布啡复合丙泊酚用于门诊人工流产术麻醉的疗效及安全性[J]. 河北医科大学学报, 2018, 39(11): 1324-1329. https://www.cnki.com.cn/Article/CJFDTOTAL-HBYX201811021.htm

    CHEN Y X, CHANG H P, ZHANG J, et al. Efficacy and safety of combined intravenous anesthesia with nalbuphine and propofol during painless induced abortion surgery[J]. Journal of Hebei Medical University, 2018, 39(11): 1324-1329. https://www.cnki.com.cn/Article/CJFDTOTAL-HBYX201811021.htm
    [19] 袁红, 钟海, 刘天品, 等. 双通道面罩用于无痛纤维支气管镜检查术患者气道管理的效果[J]. 中华麻醉学杂志, 2017, 37(8): 1019-1020.

    YUAN H, ZHONG H, LIU T P, et al. Efficacy of double channel mask for airway management in patients undergoing painless fiberoptic bronchoscopy[J]. Chinese Journal of Anesthesilolgy, 2017, 37(8): 1019-1020.
    [20] 张杨, 陈霞, 马浩南. Ambu AuraGain喉罩用于无痛纤维支气管镜检查术患者气道管理的效果[J]. 中华麻醉学杂志, 2020, 40(10): 1228-1231. https://www.cnki.com.cn/Article/CJFDTOTAL-YXYZ202203020.htm

    ZHANG Y, CHEN X, MA H L. Efficacy of laryngeal mask airway Ambu AuraGain for airway management in patients undergoing painless fiberoptic bronchoscopy[J]. Chinese Journal of Anesthesilolgy, 2020, 40(10): 1228-1231. https://www.cnki.com.cn/Article/CJFDTOTAL-YXYZ202203020.htm
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  • 收稿日期:  2021-11-25
  • 网络出版日期:  2023-02-07

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