目的 探讨右美托咪定滴鼻应用于老年患者纤维支气管镜检查的安全有效剂量。方法 选取2021-02至2021-12在解放军总医院第一医学中心行纤维支气管镜检查的老年患者75例,采用随机数字表法分为右美托咪定1 μg/kg组(D1组),右美托咪定2 μg/kg组(D2组)和生理盐水组(C组),每组25例。在检查开始前30 min根据分组及计算剂量进行滴鼻,观察记录患者在检查过程中的镇静评分(Ramsay评分)、患者舒适度、术者满意度,记录滴鼻前(T0)、手术开始前(T1)、纤维气管镜到达隆突前(T2)、取活检时(T3)、手术结束时(T4)、出室时(T5)的心率(heart rate , HR)、平均动脉压(mean arterial pressure, MAP)、脉搏血氧饱和度(saturation of pulse oximetry, SPO2%)的变化,呛咳次数和程度以及体动、恶心呕吐等不良反应。结果 D1组、D2组Ramsay评分高于C组,且D2组的Ramsay评分高于D1组(P<0.05)。D1、D2组患者满意度评分和术者满意度评分均高于C组(P<0.05)。D2组患者心率在T2-4时低于C组,D2组患者在T2-5时的平均动脉压低于C组(P<0.05)。D1组、D2组患者的呛咳发生率低于C组(P<0.01),D2组患者呛咳发生率低于D1组(P<0.05),D1、D2组患者术中追加局麻药例数少于C组(P<0.01),术后恶心呕吐、不良记忆等不良反应发生率差异无统计学意义。结论 术前给予右美托咪定滴鼻应用于老年患者纤维支气管镜检查安全有效,镇静效果良好,患者血流动力学稳定,不良反应发生率低,其中以2 μg/kg剂量滴鼻镇静效果更好。
Abstract
Objective To investigate the safe and effective dose of intranasal dexmedetomidine in elderly patients undergoing fiberoptic bronchoscopy. Methods Seventy-five elderly patients who underwent fiberoptic bronchoscopy in the first Medical Center of PLA General Hospital from February 2021 to December 2021 were selected and randomly divided into three groups , with 25 patients in each group: the dexmedetomidine 1 μg/Kg group (group D1), the dexamethasone 2 μg/Kg group (group D2) and the normal saline group (control group, group C). At thirty minutes before the examination, intranasal instillation was performed according to the group and the calculated dose, and the sedation score (Ramsay score), patients' comfort level, and operator satisfaction during the examination were recorded. Heart rate (HR), mean arterial pressure (MAP), saturation of pulse oximetry (SPO2%) were recorded respectively before nasal instillation (T0), before surgery (T1), before fiberoptic bronchoscope reaches the carina (T2), at the time of biopsy (T3), at the end of surgery (T4), and at the time of exiting the operation room (T5). The frequency and degree of choking and the adverse reactions such as body movement, nausea and vomiting were also recorded. Results The Ramsay scores of group D1 and group D2 were higher than those in group C, and the Ramsay score of group D2 was higher than that in group D1 (P<0.05). The patient satisfaction scores and operator satisfaction scores in groups D1 and D2 were higher than those in group C (P<0.05). The heart rate in group D2 was lower than in group C at T2-4, and the mean arterial pressure in group D2 was lower than in group C at T2-5 (P<0.05). The incidence of choking in group D1 and D2 was lower than in group C(P<0.001), the incidence of choking in group D2 was lower than in group D1(P<0.05), and the additional frequency of local anesthetics in groups D1 and D2 was less than in group C (P<0.001). There was no significant difference in the incidence of adverse reactions such as nausea, vomiting, and poorly-functioning memory. Conclusion Preoperative intranasal administration of dexmedetomidine in elderly patients is safe and effective for fiberoptic bronchoscopy, with good sedative effect, stability hemodynamics, and low incidence of adverse reactions, and 2 μg/kg intranasal sedation has a better sedative effect, which is worthy of clinical application.
关键词
纤维支气管镜 /
老年人 /
盐酸右美托咪定 /
滴鼻
Key words
fiberoptic bronchoscopy /
elderly patients /
dexmedetomidine /
nasal drop
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