Article(id=1246531408919945834, tenantId=1146029695717560320, journalId=1246415772164075586, issueId=1246531406415941821, articleNumber=null, orderNo=null, doi=10.13699/j.cnki.1001-6821.2025.16.001, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1746460800000, receivedDateStr=2025-05-06, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1775125847319, onlineDateStr=2026-04-02, pubDate=1756310400000, pubDateStr=2025-08-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1775125847319, onlineIssueDateStr=2026-04-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1775125847319, creator=13701087609, updateTime=1775125847319, updator=13701087609, issue=Issue{id=1246531406415941821, tenantId=1146029695717560320, journalId=1246415772164075586, year='2025', volume='41', issue='16', pageStart='2251', pageEnd='2400', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=1, specialIssue=null, createTime=1775125846723, creator=13701087609, updateTime=1775125956861, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1246531868481446285, tenantId=1146029695717560320, journalId=1246415772164075586, issueId=1246531406415941821, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1246531868481446286, tenantId=1146029695717560320, journalId=1246415772164075586, issueId=1246531406415941821, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2251, endPage=2256, ext={EN=ArticleExt(id=1246531409582645871, articleId=1246531408919945834, tenantId=1146029695717560320, journalId=1246415772164075586, language=EN, title=Clinical study of preoperative lidocaine combined with dexmedetomidine in fiberoptic bronchoscopy under general anesthesia for patients with pulmonary tuberculosis, columnId=1246531407326105792, journalTitle=Chinese Journal of Clinical Pharmacology, columnName=Clinical and Basic Bridging Research, runingTitle=null, highlight=null, articleAbstract=
Objective

To observe the clinical efficacy and safety of preoperative medication with lidocaine hydrochloride injection ultrasonic atomization combined with low-dose dexmedetomidine hydrochloride injection for fiberoptic bronchoscopy under general anesthesia in patients with pulmonary tuberculosis.

Methods

Patients with pulmonary tuberculosis scheduled for general anesthesia fiberoptic bronchoscopy were randomly divided into treatment group and control group. Both groups were given intravenous infusions of fentanyl citrate injection 0.05 mg and 1.5 mg·kg-1 propofol medium and long chain fat emulsion injection for induction of anesthesia. During the procedure, 2-3 mg·kg-1·h-1 propofol medium and long chain fat emulsion injection was used to maintain anesthesia. Control group received no additional treatment, while treatment group received an additional intravenous infusion of 0.2 μg·kg-1 dexmedetomidine hydrochloride injection through micro-pump over 15 min, combined with nebulized inhalation of lidocaine hydrochloride injection 3-4 mL, before induction of anesthesia. The postoperative anesthesia status, recovery quality, inflammation-related indicators and safety were compared between the two groups.

Results

Among the 95 patients with pulmonary tuberculosis who underwent fiberoptic bronchoscopy under general anesthesia, 3 cases dropped out during the treatment and finally 46 cases were included in each group. After treatment, the loss of consciousness time in control group and treatment group were (172.65±36.81) and (146.67±26.46)s, respectively; the recovery time were (18.67±1.06) and (15.50±0.75) min, respectively; the orientation recovery time were (16.63±1.76) and (9.57±1.70) min and the dosage of propofol were (130.21±13.41) and (124.02±15.43) mg, respectively; the Ramsay scores of 10 minutes after awakening were (3.09±0.51) and (2.57±0.62) points, respectively; the Ramsay scores of 20 minutes after awakening were (3.52±0.55) and (3.00±0.67) points, respectively; the levels of death-associated protein kinase 1 (DAPK1) were (88.08±9.85) and (81.88±11.55) ng·L-1, respectively; the levels of NOD-like receptor family pyrin domain-containing 3 (NLRP3) were (78.63±9.35) and (73.96±7.52) ng·L-1, respectively; the levels of interleukin-1β (IL-1β) were (46.02±4.59) and (41.04±6.62) ng·L-1, respectively and the levels of IL-18 were (5.71±1.64) and (4.78±1.23) ng·L-1, respectively. The differences of the above indexes between treatment group and control group were statistically significant (all P<0.05). The main adverse drug reactions of control group were tinnitus, dizziness, nausea, agitation and convulsion; in treatment group were dizziness, nausea, agitation and convulsion, the total incidence of adverse drug reactions in control group was 13.04% (6 cases/46 cases), while that in treatment group was 8.70% (4 cases/46 cases). There was no statistically significant difference between the two groups (P>0.05).

Conclusion

Lidocaine hydrochloride injection combined with low-dose dexmedetomidine hydrochloride injection has significant advantages in patients with pulmonary tuberculosis undergoing fiberoptic bronchoscopy under general anesthesia. It can effectively improve the anesthetic effect and recovery quality of patients, reduce the dosage of propofol and reduce the levels of inflammatory factors with with good safety.

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目的

观察盐酸利多卡因注射液联合低剂量盐酸右美托咪定注射液对肺结核患者全麻纤维支气管镜诊疗的临床疗效和安全性。

方法

将拟行全麻纤维支气管镜诊疗的肺结核患者随机分为试验组和对照组,2组均给予枸橼酸芬太尼注射液0.05 mg和1.5 mg·kg-1丙泊酚中/长链脂肪乳注射液静脉输注诱导麻醉,术中2~3 mg·kg-1·h-1丙泊酚中/长链脂肪乳注射液维持麻醉;对照组不再增加其他治疗,试验组在麻醉诱导前再给予0.2 μg·kg-1盐酸右美托咪定注射液,微量泵输注15 min,联合盐酸利多卡因注射液3~4 mL雾化吸入。比较2组患者术后麻醉情况、苏醒质量、炎症反应相关指标,并评价安全性。

结果

在95例接受全麻纤维支气管镜诊疗的肺结核患者中,试验过程共脱落3例,最终对照组和试验组各纳入46例。治疗后,对照组和试验组术后意识消失时间分别为(172.65±36.81)和(146.67±26.46)s,苏醒时间分别为(18.67±1.06)和(15.50±0.75)min,定向力恢复时间分别为(16.63±1.76)和(9.57±1.70)min,丙泊酚用量分别为(130.21±13.41)和(124.02±15.43)mg;苏醒10 min的Ramsay评分分别为(3.09±0.51)和(2.57±0.62)分;苏醒20 min的Ramsay评分分别为(3.52±0.55)和(3.00±0.67)分;治疗后,对照组和试验组死亡相关蛋白激酶1(DAPK1)水平分别为(88.08±9.85)和(81.88±11.55)ng·L-1;NOD样受体热蛋白结构域相关蛋白3(NLRP3)水平分别为(78.63±9.35)和(73.96±7.52)ng·L-1;白细胞介素-1β(IL-1β)水平分别为(46.02±4.59)和(41.04±6.62)ng·L-1;IL-18水平分别为(5.71±1.64)和(4.78±1.23)ng·L-1,试验组的上述指标与对照组比较,在统计学上差异均有统计学意义(均P<0.05)。对照组主要的药物不良反应为头晕、耳鸣、恶心、躁动和抽搐;试验组为头晕、恶心、躁动和抽搐,对照组的药物总不良反应发生率为13.04%(6例/46例),试验组为8.70%(4例/46例),在统计学上差异无统计学意义(P>0.05)。

结论

盐酸利多卡因注射液联合低剂量盐酸右美托咪定注射液用于肺结核患者全麻纤维支气管诊疗具有显著优势,可有效改善患者的麻醉效果与苏醒质量,减少丙泊酚用量,降低炎症因子水平,且安全性良好。

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赵崇法,主任医师MP:18920180133 E-mail:
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李世宇(1989- ),男,主治医师,主要从事麻醉方面的临床工作和研究

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tenantId=1146029695717560320, journalId=1246415772164075586, articleId=1246531408919945834, doi=null, pmid=null, pmcid=null, year=2024, volume=46, issue=2, pageStart=94, pageEnd=95, url=null, language=null, rfNumber=[1], rfOrder=0, authorNames=苗建来, 梁如钰, journalName=中国防痨杂志, refType=null, unstructuredReference=苗建来,梁如钰. 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ED50 of ciprofol combined with sufentanil for fiberoptic bronchoscopy of different patient populations with pulmonary tuberculosis[J]. BMC Anesthesiol202424(1):197., articleTitle=ED50 of ciprofol combined with sufentanil for fiberoptic bronchoscopy of different patient populations with pulmonary tuberculosis, refAbstract=null), Reference(id=1246531421385416892, tenantId=1146029695717560320, journalId=1246415772164075586, articleId=1246531408919945834, doi=null, pmid=null, pmcid=null, year=2025, volume=25, issue=1, pageStart=403, pageEnd=null, url=null, language=null, rfNumber=[13], rfOrder=12, authorNames=LI H, LI C, WEI S, journalName=BMC Anesthesiol, refType=null, unstructuredReference=LI HLI CWEI Set al. Remimazolam is more suitable for general anesthesia bronchoscopy in tuberculosis patients treated with isoniazid: A retrospective cohort analysis[J]. 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Dexmedetomidine as an adjuvant in peripheral nerve block[J/OL]. Drug Des Devel Ther2023,17:1463-1484.2023-05-17[2025-04-11].https://pubmed.ncbi.nlm.nih.gov/37220544/., articleTitle=Dexmedetomidine as an adjuvant in peripheral nerve block, refAbstract=null), Reference(id=1246531421913899236, tenantId=1146029695717560320, journalId=1246415772164075586, articleId=1246531408919945834, doi=null, pmid=null, pmcid=null, year=2021, volume=43, issue=21, pageStart=3246, pageEnd=3249, url=null, language=null, rfNumber=[18], rfOrder=17, authorNames=董文泽, 张丽伟, journalName=河北医药, refType=null, unstructuredReference=董文泽,张丽伟. 雾化吸入表面麻醉联合右美托咪定对行纤维支气管镜检查患者血流动力学、应激反应的影响[J]. 河北医药202143(21):3246-3249., articleTitle=雾化吸入表面麻醉联合右美托咪定对行纤维支气管镜检查患者血流动力学、应激反应的影响, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1246531415614055212, tenantId=1146029695717560320, journalId=1246415772164075586, articleId=1246531408919945834, xref=null, ext=[AuthorCompanyExt(id=1246531415626638125, tenantId=1146029695717560320, journalId=1246415772164075586, articleId=1246531408919945834, companyId=1246531415614055212, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Anesthesiology, Tianjin Haihe Hospital, Tianjin Institute of Respiratory Diseases, TCM Key Research Laboratory for Infectious Disease Prevention for State Administration of Traditional Chinese Medicine, Tianjin 300350, China), AuthorCompanyExt(id=1246531415630832431, tenantId=1146029695717560320, journalId=1246415772164075586, articleId=1246531408919945834, companyId=1246531415614055212, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=天津市 海河医院 麻醉科/天津市呼吸疾病研究所/国家中医药管理局 中医药防治传染病重点研究室,天津 300350)])], figs=[ArticleFig(id=1246531417883172878, tenantId=1146029695717560320, journalId=1246415772164075586, articleId=1246531408919945834, language=EN, label=Table 1, caption=

Comparison of general information between the two groups

, figureFileSmall=null, figureFileBig=null, tableContent=
ItemControl(n=46)Treatment(n=46)
Age(year,38.22±7.9939.72±10.12
Gender (n, %)
Male18(39.13)16(34.78)
Female28(60.87)30(65.22)
ASA (n, %)
Level Ⅰ29(63.04)25(54.35)
Level Ⅱ17(36.96)21(45.65)
Weight(hg,)64.04±8.2965.12±9.17
Body mass index(kg·m-222.16±2.8722.64±3.46
Treatment method (n, %)
Balloon dilation13(28.26)11(23.91)
Bronchoalveolar lavage21(45.65)25(54.35)
Radiofrequency ablation12(26.09)10(21.74)
Heart rate on admission (beats·min-172.91±7.4572.32±7.82
SBP(mmHg,119.35±12.53120.73±12.91
DBP(mmHg,74.18±9.6575.84±9.17
), ArticleFig(id=1246531418000613401, tenantId=1146029695717560320, journalId=1246415772164075586, articleId=1246531408919945834, language=CN, label=表1, caption=

2组患者一般资料的比较

, figureFileSmall=null, figureFileBig=null, tableContent=
ItemControl(n=46)Treatment(n=46)
Age(year,38.22±7.9939.72±10.12
Gender (n, %)
Male18(39.13)16(34.78)
Female28(60.87)30(65.22)
ASA (n, %)
Level Ⅰ29(63.04)25(54.35)
Level Ⅱ17(36.96)21(45.65)
Weight(hg,)64.04±8.2965.12±9.17
Body mass index(kg·m-222.16±2.8722.64±3.46
Treatment method (n, %)
Balloon dilation13(28.26)11(23.91)
Bronchoalveolar lavage21(45.65)25(54.35)
Radiofrequency ablation12(26.09)10(21.74)
Heart rate on admission (beats·min-172.91±7.4572.32±7.82
SBP(mmHg,119.35±12.53120.73±12.91
DBP(mmHg,74.18±9.6575.84±9.17
), ArticleFig(id=1246531418109665320, tenantId=1146029695717560320, journalId=1246415772164075586, articleId=1246531408919945834, language=EN, label=Table 2, caption=

Comparison of anesthesia conditions and awakening quality of patients in two groups ()

, figureFileSmall=null, figureFileBig=null, tableContent=
ItemControl(n=46)Treatment(n=46)
Time of loss of consciousness(s)172.65±36.81146.67±26.46*
Wake-up time(min)18.67±1.0615.50±0.75*
Recovery time of orientation(min)16.63±1.769.57±1.70*
Dosage of propofol(mg)130.21±13.41124.02±15.43*
Ramsay score(points)
Awaken for 10 minutes3.09±0.512.57±0.62*
Awaken for 20 minutes3.52±0.553.00±0.67*
), ArticleFig(id=1246531418201940014, tenantId=1146029695717560320, journalId=1246415772164075586, articleId=1246531408919945834, language=CN, label=表2, caption=

2组患者麻醉情况及苏醒质量的比较(

, figureFileSmall=null, figureFileBig=null, tableContent=
ItemControl(n=46)Treatment(n=46)
Time of loss of consciousness(s)172.65±36.81146.67±26.46*
Wake-up time(min)18.67±1.0615.50±0.75*
Recovery time of orientation(min)16.63±1.769.57±1.70*
Dosage of propofol(mg)130.21±13.41124.02±15.43*
Ramsay score(points)
Awaken for 10 minutes3.09±0.512.57±0.62*
Awaken for 20 minutes3.52±0.553.00±0.67*
), ArticleFig(id=1246531419745443896, tenantId=1146029695717560320, journalId=1246415772164075586, articleId=1246531408919945834, language=EN, label=Table 3, caption=

Comparison of hemodynamic parameters between two groups (

, figureFileSmall=null, figureFileBig=null, tableContent=
ItemTime pointControl(n=46)Treatment(n=46)
HR(time·min-1T073.54±7.9874.63±7.63
T191.89±9.17#86.17±8.46*#
T292.24±6.57#87.39±8.50*#
T373.02±7.0372.46±8.76
MAP(mmHg)T085.37±7.8387.98±7.97
T190.46±8.06#85.17±8.84*
T283.17±6.3884.59±6.91
T387.26±11.8390.74±7.03
SpO2(%)T098.11±0.7498.02±1.02
T197.26±2.19#98.26±1.00
T297.78±1.0398.50±0.59*
T397.67±1.7997.70±1.07
), ArticleFig(id=1246531419862884421, tenantId=1146029695717560320, journalId=1246415772164075586, articleId=1246531408919945834, language=CN, label=表3, caption=

2组患者血流动力学指标的比较(

, figureFileSmall=null, figureFileBig=null, tableContent=
ItemTime pointControl(n=46)Treatment(n=46)
HR(time·min-1T073.54±7.9874.63±7.63
T191.89±9.17#86.17±8.46*#
T292.24±6.57#87.39±8.50*#
T373.02±7.0372.46±8.76
MAP(mmHg)T085.37±7.8387.98±7.97
T190.46±8.06#85.17±8.84*
T283.17±6.3884.59±6.91
T387.26±11.8390.74±7.03
SpO2(%)T098.11±0.7498.02±1.02
T197.26±2.19#98.26±1.00
T297.78±1.0398.50±0.59*
T397.67±1.7997.70±1.07
), ArticleFig(id=1246531419959353418, tenantId=1146029695717560320, journalId=1246415772164075586, articleId=1246531408919945834, language=EN, label=Table 4, caption=

Comparison of inflammation-related indexes of patients in two groups (ng·L-1, )

, figureFileSmall=null, figureFileBig=null, tableContent=
ItemControl(n=46)Treatment(n=46)
DAPK188.08±9.8581.88±11.55*
NLRP378.63±9.3573.96±7.52*
IL-1β46.02±4.5941.04±6.62*
IL-185.71±1.644.78±1.23*
), ArticleFig(id=1246531420047433809, tenantId=1146029695717560320, journalId=1246415772164075586, articleId=1246531408919945834, language=CN, label=表4, caption=

2组患者炎症反应相关指标的比较(ng·L-1

, figureFileSmall=null, figureFileBig=null, tableContent=
ItemControl(n=46)Treatment(n=46)
DAPK188.08±9.8581.88±11.55*
NLRP378.63±9.3573.96±7.52*
IL-1β46.02±4.5941.04±6.62*
IL-185.71±1.644.78±1.23*
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利多卡因联合右美托咪定在肺结核患者全麻纤维支气管镜诊疗中的临床研究
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李世宇 , 盛怀晨 , 赵崇法
中国临床药理学杂志 | 临床与基础桥接研究 2025,41(16): 2251-2256
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中国临床药理学杂志 | 临床与基础桥接研究 2025, 41(16): 2251-2256
利多卡因联合右美托咪定在肺结核患者全麻纤维支气管镜诊疗中的临床研究
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李世宇, 盛怀晨, 赵崇法
作者信息
  • 天津市 海河医院 麻醉科/天津市呼吸疾病研究所/国家中医药管理局 中医药防治传染病重点研究室,天津 300350
  • 李世宇(1989- ),男,主治医师,主要从事麻醉方面的临床工作和研究

通讯作者:

赵崇法,主任医师MP:18920180133 E-mail:
Clinical study of preoperative lidocaine combined with dexmedetomidine in fiberoptic bronchoscopy under general anesthesia for patients with pulmonary tuberculosis
Shi-yu LI, Huai-chen SHENG, Chong-fa ZHAO
Affiliations
  • Department of Anesthesiology, Tianjin Haihe Hospital, Tianjin Institute of Respiratory Diseases, TCM Key Research Laboratory for Infectious Disease Prevention for State Administration of Traditional Chinese Medicine, Tianjin 300350, China
出版时间: 2025-08-28 doi: 10.13699/j.cnki.1001-6821.2025.16.001
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目的

观察盐酸利多卡因注射液联合低剂量盐酸右美托咪定注射液对肺结核患者全麻纤维支气管镜诊疗的临床疗效和安全性。

方法

将拟行全麻纤维支气管镜诊疗的肺结核患者随机分为试验组和对照组,2组均给予枸橼酸芬太尼注射液0.05 mg和1.5 mg·kg-1丙泊酚中/长链脂肪乳注射液静脉输注诱导麻醉,术中2~3 mg·kg-1·h-1丙泊酚中/长链脂肪乳注射液维持麻醉;对照组不再增加其他治疗,试验组在麻醉诱导前再给予0.2 μg·kg-1盐酸右美托咪定注射液,微量泵输注15 min,联合盐酸利多卡因注射液3~4 mL雾化吸入。比较2组患者术后麻醉情况、苏醒质量、炎症反应相关指标,并评价安全性。

结果

在95例接受全麻纤维支气管镜诊疗的肺结核患者中,试验过程共脱落3例,最终对照组和试验组各纳入46例。治疗后,对照组和试验组术后意识消失时间分别为(172.65±36.81)和(146.67±26.46)s,苏醒时间分别为(18.67±1.06)和(15.50±0.75)min,定向力恢复时间分别为(16.63±1.76)和(9.57±1.70)min,丙泊酚用量分别为(130.21±13.41)和(124.02±15.43)mg;苏醒10 min的Ramsay评分分别为(3.09±0.51)和(2.57±0.62)分;苏醒20 min的Ramsay评分分别为(3.52±0.55)和(3.00±0.67)分;治疗后,对照组和试验组死亡相关蛋白激酶1(DAPK1)水平分别为(88.08±9.85)和(81.88±11.55)ng·L-1;NOD样受体热蛋白结构域相关蛋白3(NLRP3)水平分别为(78.63±9.35)和(73.96±7.52)ng·L-1;白细胞介素-1β(IL-1β)水平分别为(46.02±4.59)和(41.04±6.62)ng·L-1;IL-18水平分别为(5.71±1.64)和(4.78±1.23)ng·L-1,试验组的上述指标与对照组比较,在统计学上差异均有统计学意义(均P<0.05)。对照组主要的药物不良反应为头晕、耳鸣、恶心、躁动和抽搐;试验组为头晕、恶心、躁动和抽搐,对照组的药物总不良反应发生率为13.04%(6例/46例),试验组为8.70%(4例/46例),在统计学上差异无统计学意义(P>0.05)。

结论

盐酸利多卡因注射液联合低剂量盐酸右美托咪定注射液用于肺结核患者全麻纤维支气管诊疗具有显著优势,可有效改善患者的麻醉效果与苏醒质量,减少丙泊酚用量,降低炎症因子水平,且安全性良好。

盐酸利多卡因注射液  /  盐酸右美托咪定注射液  /  肺结核  /  纤维支气管镜  /  麻醉
Objective

To observe the clinical efficacy and safety of preoperative medication with lidocaine hydrochloride injection ultrasonic atomization combined with low-dose dexmedetomidine hydrochloride injection for fiberoptic bronchoscopy under general anesthesia in patients with pulmonary tuberculosis.

Methods

Patients with pulmonary tuberculosis scheduled for general anesthesia fiberoptic bronchoscopy were randomly divided into treatment group and control group. Both groups were given intravenous infusions of fentanyl citrate injection 0.05 mg and 1.5 mg·kg-1 propofol medium and long chain fat emulsion injection for induction of anesthesia. During the procedure, 2-3 mg·kg-1·h-1 propofol medium and long chain fat emulsion injection was used to maintain anesthesia. Control group received no additional treatment, while treatment group received an additional intravenous infusion of 0.2 μg·kg-1 dexmedetomidine hydrochloride injection through micro-pump over 15 min, combined with nebulized inhalation of lidocaine hydrochloride injection 3-4 mL, before induction of anesthesia. The postoperative anesthesia status, recovery quality, inflammation-related indicators and safety were compared between the two groups.

Results

Among the 95 patients with pulmonary tuberculosis who underwent fiberoptic bronchoscopy under general anesthesia, 3 cases dropped out during the treatment and finally 46 cases were included in each group. After treatment, the loss of consciousness time in control group and treatment group were (172.65±36.81) and (146.67±26.46)s, respectively; the recovery time were (18.67±1.06) and (15.50±0.75) min, respectively; the orientation recovery time were (16.63±1.76) and (9.57±1.70) min and the dosage of propofol were (130.21±13.41) and (124.02±15.43) mg, respectively; the Ramsay scores of 10 minutes after awakening were (3.09±0.51) and (2.57±0.62) points, respectively; the Ramsay scores of 20 minutes after awakening were (3.52±0.55) and (3.00±0.67) points, respectively; the levels of death-associated protein kinase 1 (DAPK1) were (88.08±9.85) and (81.88±11.55) ng·L-1, respectively; the levels of NOD-like receptor family pyrin domain-containing 3 (NLRP3) were (78.63±9.35) and (73.96±7.52) ng·L-1, respectively; the levels of interleukin-1β (IL-1β) were (46.02±4.59) and (41.04±6.62) ng·L-1, respectively and the levels of IL-18 were (5.71±1.64) and (4.78±1.23) ng·L-1, respectively. The differences of the above indexes between treatment group and control group were statistically significant (all P<0.05). The main adverse drug reactions of control group were tinnitus, dizziness, nausea, agitation and convulsion; in treatment group were dizziness, nausea, agitation and convulsion, the total incidence of adverse drug reactions in control group was 13.04% (6 cases/46 cases), while that in treatment group was 8.70% (4 cases/46 cases). There was no statistically significant difference between the two groups (P>0.05).

Conclusion

Lidocaine hydrochloride injection combined with low-dose dexmedetomidine hydrochloride injection has significant advantages in patients with pulmonary tuberculosis undergoing fiberoptic bronchoscopy under general anesthesia. It can effectively improve the anesthetic effect and recovery quality of patients, reduce the dosage of propofol and reduce the levels of inflammatory factors with with good safety.

lidocaine hydrochloride injection  /  dexmedetomidine hydrochloride injection  /  pulmonary tuberculosis  /  fiberoptic bronchoscopy  /  anesthesia
李世宇, 盛怀晨, 赵崇法. 利多卡因联合右美托咪定在肺结核患者全麻纤维支气管镜诊疗中的临床研究. 中国临床药理学杂志, 2025 , 41 (16) : 2251 -2256 . DOI: 10.13699/j.cnki.1001-6821.2025.16.001
Shi-yu LI, Huai-chen SHENG, Chong-fa ZHAO. Clinical study of preoperative lidocaine combined with dexmedetomidine in fiberoptic bronchoscopy under general anesthesia for patients with pulmonary tuberculosis[J]. Chinese Journal of Clinical Pharmacology, 2025 , 41 (16) : 2251 -2256 . DOI: 10.13699/j.cnki.1001-6821.2025.16.001
肺结核由结核分枝杆菌引起,是一种发病率及病死率均较高的传染性疾病,患者感染后常出现咳痰、咯血等症状,病情严重时可伴有呼吸困难[1]。纤维支气管镜检查在肺结核诊疗中具有重要价值,但其操作过程可能对气道产生机械性刺激与损伤,导致气道反应性增高,甚至诱发气道痉挛、出血等并发症,因此对麻醉的要求较高[2]。丙泊酚具有起效快和镇静效果较好的优点,但存在单独使用所需剂量过大、静脉注射痛和呼吸循环抑制等缺陷。利多卡因可发挥抗痛觉过敏、抗炎以及镇痛等功效。术前使用右美托咪定具有剂量依赖性镇静效果,高选择性、高效性发挥镇痛作用且不会产生呼吸抑制[3]。2者联用能减少丙泊酚等麻醉药物用量[4]。本研究旨在探讨利多卡因联合低剂量右美托咪定用于全麻纤维支气管镜诊疗肺结核患者的临床疗效及安全性,为安全、有效的临床麻醉方案及用药选择提供参考。
本研究按照前瞻性、随机、对照、单中心、单盲、临床研究方法设计。
2023年7月至2024年7月以本院行全麻纤维支气管镜诊疗的肺结核患者入选为研究对象。本研究经天津市海河医院伦理委员会审批通过(伦理批号:2023HHWZ-004)。所有患者均签署知情同意书。
纳入标准 符合《WS 288—2017肺结核诊断》[5]中关于肺结核的诊断标准者(经胸部影像学检查发现存在结核病变,痰涂片或培养、结核菌素试验等检查为阳性,存在发热、盗汗、厌食和体质量减轻的症状且持续时间超过6周,对抗结核治疗有反应),美国麻醉医师协会分级为Ⅰ~Ⅱ级者,年龄≥18岁者,计划行纤维支气管镜检查与治疗者,心肺功能基本正常者,无麻醉药物过敏史者。
排除标准 合并严重肝肾功能不全者,有严重心血管疾病者,有气道严重狭窄或梗阻者,妊娠期或哺乳期妇女,近1个月有上呼吸道感染或肺部感染未愈的患者,有凝血功能障碍者。
丙泊酚中/长链脂肪乳注射液,规格:每支20 mL/0.2 g,批号:22110131、22111631、24050931,批准文号:国药准字H20213012,扬子江药业集团有限公司生产;盐酸右美托咪定注射液,规格:按C13H16N2计,每支2 mL/200 μg,批号:23012431、23121531,批准文号:国药准字H20213699,石家庄四药有限公司生产;盐酸利多卡因注射液,规格:每支5 mL/0.1 g,批号:71230105、71230113、71240408,批准文号:国药准字H20023777,上海禾丰制药有限公司生产;枸橼酸芬太尼注射液,规格:每支2 mL/0.1 mg,批号:21D10111,批准文号:国药准字H42022076,宜昌人福药业有限责任公司生产。NOD样受体热蛋白结构域相关蛋白3(NOD-like receptor family pyrin domain-containing 3,NLRP3)、死亡相关蛋白激酶1(death-associated protein kinase 1,DAPK1)、白细胞介素-1β(interleukin-1 beta,IL-1β)和IL-18酶联免疫吸附实验试剂盒,均由北京万泰生物药业股份有限公司生产。
BeneVision T5心电监护仪,深圳迈瑞公司产品;SynergyHTX酶标仪,美国Biotek公司产品。
将患者根据随机数表法分为试验组和对照组。2组患者术前禁食禁饮,开放静脉通道。进入手术室后监测患者生命体征,指标包括呼吸频率、心率(heart rate,HR)和经皮动脉血氧饱和度(saturation of peripheral oxygen,SpO2),并行常规鼻罩给氧,氧流量为8 L·min-1,保持SpO2≥95%,观察患者的呼吸情况。
麻醉诱导 试验组患者在麻醉诱导前给予0.2 μg·kg-1盐酸右美托咪定注射液,微量泵输注15 min,盐酸利多卡因注射液雾化吸入,速度为2 mL·min-1,持续15~20 min,利多卡因总用量为3~4 mL。随后2组患者均给予静脉输注枸橼酸芬太尼注射液0.05 mg和1.5 mg·kg-1丙泊酚中/长链脂肪乳注射液进行麻醉诱导,在睫毛反射消失后置入支气管镜。
麻醉维持 2组患者术中均静脉输注2~3 mg·kg-1·h-1丙泊酚中/长链脂肪乳注射液维持麻醉,密切观察患者生命体征的变化,若患者发生体动则追加0.5 mg·kg-1·time-1丙泊酚中/长链脂肪乳注射液,直至满足麻醉要求。
麻醉情况及苏醒质量[6-7] 在研究过程中,统计2组患者意识消失时间、苏醒时间、定向力恢复时间以及丙泊酚用量。用瑞姆赛镇静评分(Ramsay sedation scale,Ramsay)评价2组患者术后镇静情况,1~6分分别表示深度烦躁到极度镇静,患者Ramsay评分为2~4分为适宜的镇静状态。
血流动力学[8] 用心电监护仪检测并记录2组患者麻醉开始前(T0)、气管镜进入声门时(T1)、经气管镜进行刷检和灌洗等操作时(T2)及气管镜撤出后(T3)的HR、平均动脉压(mean arterial pressure,MAP)和SpO2
炎症反应相关指标[9] 用酶联免疫吸附试剂盒及酶标仪检测2组患者术后DAPK1、NLRP3、IL-1β和IL-18水平。
安全性评价[10] 统计支气管镜诊疗过程中及术后24 h内2组患者药物不良反应的发生情况。
用SPSS 24.0软件进行统计分析,计量资料用表示,2组间比较用独立样本t检验,组内多时间点对比用重复测量方差检验,组内2时间点对比用配对样本t检验;计数资料以率(%)表示,2组间比较用χ2检验。
本研究共筛选100例,入组95例,其中,对照组47例、试验组48例。对照组因转院脱落1例,最终纳入46例;试验组因中途退出脱落1例,自行撤回知情同意书脱落1例,最终纳入46例。试验组和对照组患者的年龄、性别、血压等一般资料比较,在统计学上差异均无统计学意义(均P>0.05),组间具有可比性,见表1
试验组患者的意识消失时间、苏醒时间和定向力恢复时间均显著短于对照组(均P<0.05),丙泊酚用量均显著少于对照组(均P<0.05)。试验组患者苏醒10 min和苏醒20 min时,Ramsay评分均显著低于对照组(P<0.05),见表2
与T0时相比,2组患者在T1和T2时的HR均显著升高(均P<0.05),在T3时的HR在统计学上差异无统计学意义(P>0.05);且试验组患者在T1和T2时的HR均显著低于对照组(均P<0.05)。与T0时相比,对照组在T1时的MAP值显著升高(P<0.05);且试验组在T1时的MAP值显著低于对照组(P<0.05)。与T0时相比,对照组在T1时的SpO2值显著降低(P<0.05),试验组在T2时的SpO2值显著升高(P<0.05),见表3
治疗后,试验组患者的DAPK1、NLRP3、IL-1β和IL-18水平均显著低于对照组(均P<0.05),见表4
对照组中,发生头晕患者1例、耳鸣患者1例、恶心患者1例、抽搐患者2例、躁动患者1例,药物不良反应总发生率为13.04%(6例/46例);试验组中,发生头晕患者1例、恶心患者1例、抽搐患者1例、躁动患者1例,药物不良反应总发生率为8.70%(4例/46例),2组患者药物不良反应总发生率比较,在统计学上差异无统计学意义(P>0.05)。
作为肺结核诊疗的关键技术,纤维支气管镜检查具有操作便捷的优点,但其显著的气道刺激性易诱发剧烈呛咳,而肺结核患者呛咳可提升病原体播散风险,优化麻醉策略至关重要[11-13]。丙泊酚在纤维支气管镜麻醉中应用较广,起效快、恢复迅速且清除率高。近年来,丙泊酚联合阿片类药物已成为内镜检查麻醉的标准,在诱导意识消失、抑制机体应激反应方面协同作用显著,但易引发呼吸循环抑制及术后恶心呕吐等药物不良反应[14]。利多卡因主要通过作用于电压门控钠通道,减少钠离子内流,抑制神经冲动的传导,通过雾化方式给药可提高药物使用效率,镇痛效果较好。右美托咪定可以抑制初级传入纤维的递质释放,延长阻滞时间,小剂量使用对呼吸的抑制作用较小。徐天等[15]研究发现,利多卡因和右美托咪定在麻醉效应上存在协同作用,靶控输注方式应用于无痛胃肠镜麻醉能获得更优的麻醉效果,提升血流动力学指标的稳定性。徐四七等[16]研究发现,在麻醉诱导前,通过静脉泵注的方式联合应用利多卡因与右美托咪定,术后恢复质量和疼痛得以改善。本研究发现,试验组患者的意识消失时间、苏醒时间、定向力恢复时间、苏醒10和20 min时Ramsay评分及丙泊酚用量均显著低于对照组,表明行全麻纤维支气管镜诊疗的肺结核患者应用利多卡因联合低剂量右美托咪定术前给药,能够明显改善麻醉情况与苏醒质量,降低丙泊酚用量。利多卡因的作用机制在于它能阻断神经细胞膜上的钠离子通道,进而对神经冲动传导产生抑制作用;右美托咪定通过与脊髓α2受体的后角相结合,减少神经递质释放并阻断痛觉信号向中枢神经系统传导,2者联用能够更好地产生麻醉效果[17]。此外,本研究提示,该联合应用方案安全性良好。
维持术中血流动力学稳定是提高麻醉有效性和安全性的关键。本研究发现,试验组在T1和T2时的HR值均显著低于对照组,试验组在T1时的MAP值显著低于对照组,对照组在T1时的SpO2值显著降低,试验组在T2时的SpO2值显著升高,提示该联合应用方案可明显减少患者血流动力学的波动,降低其血压和应激反应,减少对呼吸的抑制作用,与董文泽等[18]的研究结果一致。此外,本研究中发现试验组与炎症反应相关的DAPK1、NLRP3、IL-1β和IL-18水平均显著低于对照组,提示该联合应用方案抗炎作用更为显著。
本研究提示:与常规麻醉方案相比,利多卡因联合低剂量右美托咪定用于肺结核患者全麻纤维支气管镜诊疗中的镇静作用更显著,可有效降低炎症因子水平,改善苏醒质量,减少丙泊酚用量,维持血流动力学稳定且安全性良好。尤为重要的是,丙泊酚用量的减少有助于降低术中呼吸抑制的风险,进一步体现了该联合方案在安全性方面的优势。但本研究样本量相对较少且属于单中心研究,未对不同严重程度的肺结核患者进行分层分析,未来需多中心大样本验证。
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2025年第41卷第16期
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doi: 10.13699/j.cnki.1001-6821.2025.16.001
  • 接收时间:2025-05-06
  • 首发时间:2026-04-02
  • 出版时间:2025-08-28
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  • 收稿日期:2025-05-06
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    天津市 海河医院 麻醉科/天津市呼吸疾病研究所/国家中医药管理局 中医药防治传染病重点研究室,天津 300350

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赵崇法,主任医师MP:18920180133 E-mail:
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2种不同金属材料的力学参数

Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)

Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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