The Application of Atropine in General Anaesthesia of Retaining Spontaneous Breathing for Painless Fiberoptic Bronchoscopy
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摘要:
目的 研究阿托品在保留自主呼吸无痛纤维支气管镜（纤支镜）检查中的作用。 方法 40例拟行无痛纤支镜检查的患者，随机分为2组，每组20 例。对照组（C组）依次给予舒芬太尼0.1 μg/kg、右美托咪定0.2 μg/kg、丙泊酚1 mg/kg、瑞芬太尼0.2 μg/kg、丙泊酚1 mg/kg iv，然后再配合气管内表面麻醉行纤支镜检查，当出现呛咳、肢体活动，则追加丙泊酚0.4 mg/kg iv。观察组（S组）给予阿托品0.006 mg/kg iv后其余步骤同C组。记录2组患者不同时间点的生命体征变化情况、手术时间、苏醒时间、离室时间、麻醉效果评价、术中追加丙泊酚和使用血管活性药的例数、呼吸系统不良事件及术后不良事件的发生率。 结果 2组患者术前和术后3 min的心率（HR）、血压（MAP）、血氧饱和度（SpO2）组间比较无差异（P > 0.05），C组患者T 2的HR、MAP的显著低于T1（P < 0.05）, S组患者T 2的HR、MAP、SpO2显著高于C组（P < 0.05），麻醉优良率明显高于C组（ P < 0.05），苏醒时间、离室时间显著低于C组（ P < 0.01）、术中追加丙泊酚和给予血管活性药的例数及术中不良事件的发生率明显低于C组（ P < 0.05）。 结论 阿托品可提高保留自主呼吸无痛纤支镜检查麻醉的安全性。 Abstract:Objective To study the role of atropine in spontaneous breathing painless fiberoptic bronchoscopy. Methods Forty cases of patients scheduled for receivepainless fiberoptic bronchoscopy were randomly divided into 2 groups, with 20 cases in each group.The patients in the control group （group C） were gven the intravenous anesthesia with sufentanil 0.1 μg/kg, dexmedetomidine 0.2 μg/kg, propofol 1 mg/kg, remifentanil 0.2 μg/kg, propofol 1 mg/kg, then endotracheal fiberoptic bronchoscopy were conducted cooperating with the endotracheal surface anesthesia.An extra propofol 0.4 mg/kg was given when choking cough or body moving occurred.The patients in the observation group （group S） were given atropine 0.006 mg/kg intravenous injection, the subsequent processing was the same as for group C. The changes of vital signs at different points during the perioperative period, the time of operation, anesthesia recovery and leaving operation room, the excellent and good rate for anesthesia, the number of cases of propofol supplementation and use of vasoactive drugs, the incidence of intraoperative respiratory adverse events and postoperative adverse events were observed and compared between the two groups. Results The levels of HR, MAP and SpO2 had no significant different between the two groups on T1 （P > 0.05）, those of group S were significantly higher than group C on T 2 （P < 0.05）, the levels of HR and MAP on T 2 were significantly lower than those on T1 in group C （P < 0.05）, the rate of excellent and good of anesthesia of group S was significantly higher than that of group C （ P < 0.05）, the time of anesthesia recovery and leaving the operation room of group S were significantly lower than that of group C （ P < 0.01）, the number of cases of intraoperative propofol supplementation and use of vasoactive drugs of group S were significantly lower than those of group C （ P < 0.05）, the incidence of intraoperative respiratory adverse events of group S was significantly lower than that of group C （ P < 0.05）. Conclusion Atropine can improve the safety of the anesthesia of preserving spontaneous breathing for painless fiberoptic bronchoscopy. -
Key words:
- Atropine /
- Spontaneous breathing /
- Fiberoptic bronchoscope /
- Painless /
- Application
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表 1 2组患者一般情况的比较（ $\bar x \pm s$）
Table 1. Comparison of general conditions of two groups of patients （ $\bar x \pm {{s}}$）
组别 n 性别
（男/女，例）年龄
（A）体重
（kg）手术时间
（min）C组 20 14/6 51.6 ± 8.5 69.1 ± 9.9 7.4 ± 1.2 S组 20 15/5 52.8 ± 7.7 65.6 ± 13.7 7.1 ± 0.9 x2/t 0.125 0.432 0.912 0.896 P 0.723 0.668 0.368 0.376 
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表 2 2组患者HR、MAP、SpO2、的比较[（ $\bar x \pm s$），n = 20]
Table 2. Comparison of heart rate，mean arterial pressure，pulse oxygen saturation of two groups of patients [（ $\bar x \pm {{s}}$），n = 20]
项目 组别 T1 T2 T3 F组间，P组间 F时间，P时间 F交叉，P交叉 HR
（次/min）C组 77.05 ± 9.44 67.25 ± 11.91* 73.55 ± 9.38 2.803，0.009 1.788，0.181 42.69，< 0.000 S组 74.75 ± 8.88 83.10 ± 10.17▲ 78.10 ± 10.14 MAP
（mmHg）C组 89.50 ± 6.38 80.50 ± 5.24* 83.10 ± 5.13 3.932，0.028 4.809，0.05 0.628，< 0.001 S组 88.25 ± 4.67 90.00 ± 11.27▲ 84.40 ± 6.20 SpO2（%） C组 95.30 ± 1.56 95.32 ± 1.54 97.75 ± 1.52 5.280，0.027 51.31，< 0.000 5.608，0.005 S组 95.50 ± 1.82 99.15 ± 1.27a b 98.55 ± 1.28* 与本组 T 1 比较，*P < 0.05；与C组同时间点比较， ▲P < 0.05。
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表 3 各项指标组间比较[ $\bar x \pm s$/n（%）]
Table 3. Comparison of indicators between two group [ $\bar x \pm {\rm{s}}$/n（%）]
指标 C组 S组 χ2 /t P 麻醉苏醒时间/min 4.35 ± 1.35 2.80 ± 0.77▲ 4.467 < 0.001 离室时间/min 7.90 ± 1.48 6.35 ± 1.04▲ 3.827 < 0.001 麻醉优良 9（45） 16（80）* 5.277 0.022 术中追加丙泊酚 14（70） 7（35）* 4.912 0.027 术中给予血管活性药 11（55） 4（20）* 5.227 0.022 阿托品 5（25） 0 3.657 0.056 麻黄碱） 6（30） 4（20） 0.533 0.465 术中呼吸系统不良事件 10（50） 3（15）* 5.584 0.018 呼吸抑制 7（35） 3（15） 2.133 0.144 支气管痉挛 3（15） 0 3.243 0.072 术后不良事件 7（35） 2（10） 3.584 0.058 恶心呕吐 3（15） 0 3.243 0.072 上呼吸道梗阻 4（20） 2（10） 0.196 0.658 与C组比较，*P < 0.05， ▲P < 0.01。
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