The Effect on Bronchial Ciliary Mucus Transport Velocity of Patients with General Anesthesia by Different Clinic Dosages of Remifentanil Hydrochloride
|Keywords||Remifentanil Bronchial mucociliary transport rate|
OBJECTIVE: Remifentanil is a new u an opioid receptor agonist, efficacy strong, fast onset. Dose easy to control, because it can lower blood pressure and heart rate in recent years, clinical anesthesia for patients with general anesthesia is often used to implement hypotension anesthesia drugs, clinical practice when using the remifentanil dose range bigger. Prolonged hypotension during anesthesia is safe and has not been determined, airway mucociliary transport system is important to the body's natural defense system is one of the most important after intubation body's natural defense system, its function will be impaired will increase the risk of respiratory tract infections in patients, studies have shown, 8,80 ug / L remifentanil reducing patients isolated tracheal epithelial ciliary beat frequency. Remifentanil 0.2ug/kg/min, compared with fentanyl 0.04ug/kg/min in mechanical ventilation 60min, the bronchial mucociliary transport rate reduction when compared with mechanical ventilation 10min, now mostly in vitro studies, in vivo is unclear. Meanwhile respiratory system is the body's internal and external environment complicated by neural and humoral regulation of a variety of factors, and its response to drugs is complex. In vitro simulated environment is difficult, so this experiment in vivo tests. The actual use of remifentanil in clinical practice and controlled hypotension in large doses for a long time, this experiment to compare the clinical anesthetic dose range of three different doses of remifentanil at different time points for patients of bronchial mucociliary transport system rate implications for clinical use to find the best reduce perioperative pulmonary complications to provide a reasonable basis for narcotic drugs combined. Methods; elective anesthesia in 40 patients (19 males, 21 females), aged 18 --- 67 years, ASA Ⅰ or Ⅱ, no cardiopulmonary disease and smoking history, requiring the patient has respiratory function inspection records, three months is no smoking and respiratory tract infection, excluding the following factors: respiratory disorders, respiratory special reactivity, or taking the influence of airway mucociliary transport rate of the drug (β-receptor antagonists, cortisone, atropine, theophylline , catecholamines). To regulate the induction of anesthesia, general anesthesia was induced and maintained the same drugs, endotracheal intubation for pulmonary ventilation, no special preoperative medication history, were randomly divided into control group (C group) and remifentanil three different dose groups (R1 , R2 and R3 group), 10 cases in each group. C patients were treated with intravenous midazolam 0.05mg/kg, propofol 1.5-2.5mg/kg, fentanyl 2 ug / kg and vecuronium 0.1mg/kg induction of anesthesia, C group continued to lose surgery Fentanyl 0.04 ug · kg-1 · min-1 to maintain anesthesia, and R1, R2 and R3 group treated with intravenous midazolam 0.05mg/kg, propofol 1.5-2.5mg/kg, remifentanil too Nigeria 2u g / kg and vecuronium 0.1mg/kg induction of anesthesia, surgery, respectively pump Ru Ruifen fentanyl 0.1 ug · kg-1 · min-1, 0.2 ug · kg-1 · min-1 and 0.3 ug · kg · min-1 to maintain anesthesia. Mechanical ventilation were 30min, 60min and 120min three time points, using a modified Keller method to measure bronchial mucociliary transport rate, single-lumen endotracheal intubation can be, does not affect the mechanical ventilation in the case, from a relatively closed openings Division into fiberoptic bronchoscope into the endotracheal tube below the one on the 16th of the epidural catheter through the guide tube, the bronchoscope under direct vision to reach the bottom of the right main bronchus mucosa back through the epidural catheter injection 0.015m1 methylene blue, In one minute, bronchoscopy angle control in the middle position, the lens is always positioned dye front, avoid contact with mucous membranes, dye application 0,2,4,6 min after bronchoscopy to do markup, markup from the mucociliary transport rate , three velocity averaged to reduce errors. Measurements have a skilled application bronchoscopy doctors to operate, do not know when measured grouping. (See figure a) statistical analysis of measurement data were expressed as mean ± standard deviation as x ± s, application software SPSS11.0 statistical processing of data, group Within t test was used to compare between the two groups were compared with a group t test, count data using chi-square test, P lt; 0.05 was considered statistically significant. Result: a mechanical ventilation 30min, 60min and 120min three time points compared to the three-dose remifentanil group (R1, R2 and R3 group) with increasing doses of remifentanil, bronchial mucociliary transport rate decreases , the difference was statistically significant (P lt; 0.05); 2 control group (C group) three time points showed no significant difference (P gt; 0.05). 3 with the control group (C group) compared to mechanical ventilation 30min, 60min and 120min three time points remifentanil three dose groups (R1, R2 and R3 group) bronchial mucociliary transport rate was significantly lower, the difference statistically significant (P lt; 0.05). 4 remifentanil three dose groups (R1, R2 and R3 group) among the three groups, R2, and R3 bronchial mucociliary transport rate was significantly lower, the difference was statistically significant (P lt; 0.05). Conclusions: 1 with prolonged mechanical ventilation (30min, 60min and 120min time) in the control group (C group) at each time point was no significant difference between BTV; remifentanil three dose groups, with the dose of remifentanil increase, BTV gradually reduced each time point was significantly different (P lt; 0.05); remifentanil group and the control group (fentanyl group) compared with mechanical ventilation at each time point, R1, R2 and R3 are BTV group significantly lower than the control group (C group), the difference was statistically significant (P lt; 0.05). 2 clinical dose of remifentanil significantly inhibited BTV patients, and this inhibition with increasing doses of remifentanil and application of the extension of time increased. Three studies suggest that: a long, high doses of remifentanil hypotension, postoperative respiratory complications will increase the chance, you should pay attention to early prevention, after strengthening the respiratory care and guardianship. Tip: If the same intravenous calcium can produce high-frequency oscillations interventions more significant increase ciliary beat, accelerate the clearance of airway mucus, thereby reducing postoperative respiratory complications. Provide direction for further research, anesthesia respiratory care for such patients should pay attention to.