CAJ | 학술논문

目的探讨支气管镜下滴注肾上腺素的安全性.方法 74例中男52例,女22例,年龄20～78岁,平均年龄(53.08±12.43)岁,分为3组:①对照组27例,术前常规阿托品0.5 mg肌肉注射,2％利多卡因表面麻醉.常规支气管镜检查及治疗.术中未使用肾上腺素.②大气道组32例,术前处理及支气管镜操作同对照组,但于术中向段以上支气管黏膜表面灌注1∶20 000肾上腺素溶液(2.28±1.49) ml.③小气道组15例,术前处理及支气管镜操作同对照组,于术中用2 mm导管嵌于末梢支气管并向远端推注1∶20 000肾上腺素溶液(2.88±1.94) ml.三组间术前(给药前)基本情况具有可比性:年龄、术前收缩压、舒张压及心率差异均无统计学意义,大气道组与小气道组肾上腺素溶液用量差异亦无统计学意义.对三组病例于支气管镜检查前后的观测指标进行以下分析:①检查前后收缩压、舒张压、心率变化(自身对照);②两两比较三组间检查前后收缩压差、舒张压差、心率差;③观察给予肾上腺素后其他相关不良反应的发生情况,包括心悸、胸闷、胸痛、苍白或潮红、头痛、肌肉震颤等.结果 ①术后收缩压、舒张压及心率均有不同程度的增加(P＜0.05或P＜0.01).②给药前后收缩压差:小气道组差值＞大气道组差值＞对照组差值,小气道组收缩压差与后两组间比较差异有统计学意义(P＜0.05),小气道组心率差与对照组比较差异有统计学意义(P＜0.05).其余组间差异均无统计学意义.各组舒张压差无显著差异.③大气道组及小气道组血压及心率变化均与肾上腺素用量无相关性(r2分别为0.008及0.18,P＞0.05).④小气道组有不同比例患者出现心悸、心绞痛(3例)、震颤、皮肤潮红或苍白等.结论小气道内滴注肾上腺素可引起全身不良反应.
목적 탐토지기관경하적주신상선소적안전성.방법 74례중남52례,녀22례,년령20～78세,평균년령(53.08±12.43)세,분위3조:①대조조27례,술전상규아탁품0.5 mg기육주사,2％리다잡인표면마취.상규지기관경검사급치료.술중미사용신상선소.②대기도조32례,술전처리급지기관경조작동대조조,단우술중향단이상지기관점막표면관주1∶20 000신상선소용액(2.28±1.49) ml.③소기도조15례,술전처리급지기관경조작동대조조,우술중용2 mm도관감우말소지기관병향원단추주1∶20 000신상선소용액(2.88±1.94) ml.삼조간술전(급약전)기본정황구유가비성:년령、술전수축압、서장압급심솔차이균무통계학의의,대기도조여소기도조신상선소용액용량차이역무통계학의의.대삼조병례우지기관경검사전후적관측지표진행이하분석:①검사전후수축압、서장압、심솔변화(자신대조);②량량비교삼조간검사전후수축압차、서장압차、심솔차;③관찰급여신상선소후기타상관불량반응적발생정황,포괄심계、흉민、흉통、창백혹조홍、두통、기육진전등.결과 ①술후수축압、서장압급심솔균유불동정도적증가(P＜0.05혹P＜0.01).②급약전후수축압차:소기도조차치＞대기도조차치＞대조조차치,소기도조수축압차여후량조간비교차이유통계학의의(P＜0.05),소기도조심솔차여대조조비교차이유통계학의의(P＜0.05).기여조간차이균무통계학의의.각조서장압차무현저차이.③대기도조급소기도조혈압급심솔변화균여신상선소용량무상관성(r2분별위0.008급0.18,P＞0.05).④소기도조유불동비례환자출현심계、심교통(3례)、진전、피부조홍혹창백등.결론 소기도내적주신상선소가인기전신불량반응.
Objective To evaluate the safety of instillation of epinephrine-saline solution through bronchoscope.Methods 74 cases (52 male,22 male,20～78 years old,mean age 53.08±12.43 years) were divided into three groups:①Control group (27 cases):routine preoperative 0.5 mg atropine was injected intramuscularly,2％ lidocaine was used for topical anesthesia,routine bronchoscopy was performed,without instillation of epinephrine-saline solution through bronchoscope.②Central airways group (32 cases):preoperative treatment and bronchoscopy operation was performed as the control group,(2.28 ± 1.49 ) ml epinephrine-saline solution (1∶20 000) was instilled into bronchi proximal to segmental.③Terminal airway group (15 cases):preoperative treatment and bronchoscopy operation was performed as the control group,(2.88 ± 1.94) ml epinephrine-saline solution (1∶20000) was respectively instilled into peripheral bronchial by catheter with diameter of 2 mm.Basic information was comparable among the three groups before adminiatration:age,preoperative systolic blood pressure,diastolic blood pressure and heart rate were not different statistically.The dose of epinephrine-saline solution was not comparable between central airway group and terminal airway group.Observations before and after the bronchoscopy were analyzed:①Systolic blood pressure,diastolic blood pressure,heart rate (self-control) before and after the bronchoscopy.②The changes of systolic blood pressure,diastolic blood pressure and heart rate was analyzed before and after applying of epinephrine-saline with multiple comparison.③Other related side effects were observed after instillation of epinephrine-saline solution,including palpitation,chest distress,chest pain,pallor (or flush),headache,muscle tremor,etc.Results ①Postoperative systolic,diastolic blood pressure and heart rate were increased respectively to some degree in each group ( P ＜ 0.05 or P ＜ 0.01 ).Systolic blood pressure difference before and after administration:terminal airway group ＞ central airway group ＞ control group,there was significant difference of the systolic blood pressure between terminal airway group and other groups ( P ＜0.05),there was significant difference of heart rate between terminal airway group and control group ( P ＜ 0.05).There was no significant difference of other observations among the three groups.There was no difference of the diastolic blood pressure among the three groups.③The change of blood pressure and heart rate in central airway group and terminal airway group had no correlation with epinephrine dosage ( r2 were 0.008 and 0.18 respectively,P ＞0.05).④A portion of patients appeared palpitation,angina (3 cases),tremor,erubescence (or pallor) in the terminal airway group.Conclusions Instillation of epinephrine-saline solution into the terminal airway may result in general side effect.