盐酸纳布啡用于无痛纤维支气管镜对呛咳反应及相关指标的影响

Effect of nalbuphine hydrochloride used in painless fiberoptic bronchoscopy on cough response and related indexes

摘要:

目的 观察丙泊酚复合盐酸纳布啡或舒芬太尼在无痛纤维支气管镜检查中对患者呛咳反应、血流动力学和术中呼吸抑制等的影响。方法 将择期行无痛纤维支气管镜检查的103例患者随机分为纳布啡组（N组）、舒芬太尼组（S组）和纯丙泊酚组（C组），所有患者操作开始前经外周静脉通道注射丙泊酚复合盐酸纳布啡或舒芬太尼。其中，N组：纳布啡10～20 mg+丙泊酚100～150 mg，S组：舒芬太尼5～10 μg + 丙泊酚100～150 mg，C组：丙泊酚100～150 mg。记录入室时（T₀）、纤维支气管镜进入声门时（T₁）、检查过程中（T₂）、检查完毕（T₃）的平均动脉压（MAP）、心率（HR）、经皮动脉血氧饱和度（SpO₂）以及纤维支气管镜进入声门时呛咳程度、检查全过程托下颌面罩给氧次数等。结果 3组患者各时间点的MAP、HR、SpO₂和检查过程中托下颌次数比较，差异均无统计学意义（P > 0.05）；C组呛咳评分高于N组和S组（P < 0.05），苏醒时间长于N组和S组（P < 0.05），但N组和S组比较，差异无统计学意义（P > 0.05）。结论 小剂量盐酸纳布啡或舒芬太尼复合丙泊酚用于无痛纤维支气管镜检查，对血流动力学影响较小，同时可有效抑制操作过程中的呛咳反射，相比于单纯使用丙泊酚，未增加呼吸抑制的发生率。

Abstract:

Objective To observe the effect of propofol combined with hydrochloride nalbuphine or sufentanil on coughing response, hemodynamics, and intraoperative respiratory depression, etc. in painless bronchoscopy patients.Methods 103 patients who received selective painless fiberoptic bronchoscopy were randomly divided into nalbuphine group (N group), sufentanil group (S group), and propofol group (C group). Group N: nalbuphine 10 ~ 20 mg + propofol 100 ~ 150 mg, Group S: sufentanil 5 ~ 10 μg + propofol 100 ~ 150 mg, Group C: only propofol 100 ~ 150 mg were injected intravenously before the operation. Recorded the mean arterial pressure (MAP), heart rates (HR), blood oxygen saturation (SpO₂) were recorded when patients entering the operating room (T₀), bronchoscope entered the glottis (T₁), during the examination (T₂), after the operation was completed (T₃). Recorded the coughing score when the bronchoscope enters the glottis, and the times of mask to ventilate oxygen during the whole process.Results There was no significant difference in MAP, HR, and SpO₂ of the three groups of patients at each operation time point (P > 0.05); The cough score of group C was higher than that of group N and S (P < 0.05), and the recovery time of group C was longer than N Group and S group (P < 0.05), there was no difference between N group and S group (P > 0.05), and mask ventilation times had no difference in the three groups (P > 0.05).Conclusion Low-dose hydrochloride nalbuphine or sufentanil combined with propofol used for painless fiberoptic bronchoscopy, which has less impact on hemodynamics and can effectively inhibit the coughing reflex during operation and didn’t show increasing the occurrence of respiratory depression when compared to only use propofol.