CAJ | 학술논문

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.
목적 탐토우미탁미정보조표면마취용우환자지기관폐포관세술적효과.방법 의행지기관폐포관세술적ICU환자24례,ASA분급Ⅱ혹Ⅲ급,체중50～80 kg,년령24～64세,채용수궤수자표법,장환자수궤분위2조(n=12),A조술전30 min정맥주사0.9%생리염수5 ml,술전5 min경기관도관혹기관투관내주입2%리다잡인5～10 ml,수후안수매15～30 min경섬유지기관경추가2%리다잡인5 ml,총량공제재20 ml이내;B조술전30 min완만정맥주사우미탁미정0.5～1.0 μg/kg,수후이0.1～0.5 μg·kg-1·h-1속솔유지,표면마취방법동A조.기록관세시간、불량반응급심혈관불량사건적발생정황.우관세전20 min(T1)、관세개시후20 min(T2)、관세결속후20 min(T3)시채집혈양,측정혈장인다분알농도화혈청피질순농도.결과 여A조비교,B조혈청피질순농도、혈장인다분알농도강저、불량반응급심혈관불량사건발생솔강저,조작시간축단(P<0.05).여T1시비교,A조T2,3시혈청피질순급혈장인다분알농도승고,B조T2,3시혈청피질순급혈장인다분알농도강저(P<0.05).결론 우미탁미정보조표면마취가안전유효지용우환자지기관폐포관세술.
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.