右美托咪啶辅助表面麻醉用于患者支气管肺泡灌洗术的效果  

Efficacy of dexmedetomidine- assisted topical anesthesia in patients undergoing bronchoalveolar lavage

作　　者：周金萍[1] 蔡璐[1] 陈公锦[1] 王淼[1] 刘冬炎[1] 金原野[1] 马连军[1] 袁飞[1] 

机构地区：[1]浙江省绍兴第二医院麻醉科,312000

出　　处：《中华麻醉学杂志》2011年第2期208-210,共3页Chinese Journal of Anesthesiology

基　　金：绍兴市科技计划项目（2010D1003）

摘　　要：目的 探讨右美托咪啶辅助表面麻醉用于患者支气管肺泡灌洗术的效果.方法 拟行支气管肺泡灌洗术的ICU患者24例,ASA分级Ⅱ或Ⅲ级,体重50～80 kg,年龄24～64岁,采用随机数字表法,将患者随机分为2组（n=12）,A组术前30 min静脉注射0.9%生理盐水5 ml,术前5 min经气管导管或气管套管内注入2%利多卡因5～10 ml,随后按需每15～30 min经纤维支气管镜追加2%利多卡因5 ml,总量控制在20 ml以内;B组术前30 min缓慢静脉注射右美托咪啶0.5～1.0 μg/kg,随后以0.1～0.5 μg·kg-1·h-1速率维持,表面麻醉方法同A组.记录灌洗时间、不良反应及心血管不良事件的发生情况.于灌洗前20 min（T1）、灌洗开始后20 min（T2）、灌洗结束后20 min（T3）时采集血样,测定血浆儿茶酚胺浓度和血清皮质醇浓度.结果 与A组比较,B组血清皮质醇浓度、血浆儿茶酚胺浓度降低、不良反应及心血管不良事件发生率降低,操作时间缩短（P〈0.05）.与T1时比较,A组T2,3时血清皮质醇及血浆儿茶酚胺浓度升高,B组T2,3时血清皮质醇及血浆儿茶酚胺浓度降低（P〈0.05）.结论 右美托咪啶辅助表面麻醉可安全有效地用于患者支气管肺泡灌洗术.Objective To investigate the efficacy of dexmedetomidine-assisted topical anesthesia in patients undergoing bronchoalveolar lavage （ BAL）. Methods Twenty-four ASA Ⅱ or Ⅲ patients in ICU, aged 24-64 yr, weighing 50-80 kg, scheduled for BAL, were randomly divided into 2 groups （ n = 12 each） ： topical anesthesia group （group A） , topical anesthesia ＋ dexmedetomidine group （group B） . In group A, 0.9% normal saline 5 ml was injected intravenously 30 min before operation, 2% lidocaine 5-10 ml was given via a tracheal tube or cannula 5 min before operation and then an increment of 2% lidocaine 5 ml was given using fibreoptic bronchoscope every 15-30 min as required （the total amount was within 20 ml） . In group B, dexmedetomidine 0.5-1.0 μg/kg was injected （time of injection≥ 10 min） followed by infusion at 0.1-0.5 μg·kg-1 ·h-1 and the topical anesthesia was performed as the method described in group A. The time of lavage, adverse reactions and adverse cardiovascular events were recorded. Blood samples were taken 20 min before lavage, 20 min after the start of lavage and 20 min after the end of lavage （T1-3 ） for determination of the concentrations of plasma catecholamine and serum cortisol. Results The incidences of adverse reactions and adverse cardiovascular events were significantly lower and the operation time was significantly shorter in group B than in group A （ P 〈 0.05）. The concentrations of plasma catecholamine and serum cortisol were significantly higher at T2，3 in group A, while lower at T2，3 in group B than at T1 （ P 〈 0.05） . The concentrations of plasma catecholamine and serum cortisol were significantly lower in group B than in group A （ P 〈 0.05）. Conclusion Dexmedetomidine-assisted topical anesthesia can be used safely and effectively in BAL.

关 键 词：右美托咪啶 麻醉 局部 支气管肺泡灌洗 

分 类 号：R614[医药卫生—麻醉学]