Nebulized Ipratropium bromide protects against tracheal and bronchial secretion during bronchoscopy A randomized controlled trial
Nebulized Ipratropium bromide protects against tracheal and bronchial secretion during bronchoscopy A randomized controlled trial
复制标题
雾化异丙托溴铵可防止支气管镜检查期间气管和支气管分泌物一项随机对照试验
DOI：
10.1097/md.0000000000017942
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发表时间：
2019
期刊：
影响因子：
1.6
通讯作者：
Luo Fengming
中科院分区：
文献类型：
--
作者：
Wang Faping;Zheng He;Zhang Yanlin;Zhu Hui;Shi Jingyu;Luo Yunxiao;Zhang Xiang;Mao Hui;Herth Felix J. F.;Luo Fengming
背景：在纤维支气管镜检查前给予抗胆碱能药物已被调查过，但研究没有得出一致的结果。方法：患者被随机分为4毫升异丙托溴铵(1 mg，n=125)或安慰剂(n=125)雾化吸入15分钟，在支气管镜检查前20-40分钟。结果：支气管镜检查前雾化吸入异丙托溴铵可减少呼吸道分泌物，减少患者不适(P=0.0 5)。P<；。001)，但与气管、支气管出血或手术时间无关(P=.51，P=.分别为36)。胸部结节或肿块是最常见的支气管镜检查指征。结论：纤维支气管镜检查前雾化吸入异丙托溴铵是一种更有效的治疗方案，对呼吸道分泌物和病人的舒适度有实际的好处，但这些作用并不能显著减少出血或减少全身麻醉下的手术时间。我们建议常规雾化吸入溴化异丙托品用于支气管镜检查前用药可能是有用和有益的。Org.介绍柔性支气管镜在50年前被引入肺科。[1]随着一些技术的进步，它已经成为许多肺部疾病的宝贵诊断工具，是一种安全的手术，发病率低(0.1-2.5%)，死亡率非常低(0.05%)。[2]然而，全身麻醉时气管和支气管内的高分泌使支气管镜医生难以观察和履行职责。M3乙酰胆碱受体主要分布于呼吸道平滑肌、粘膜下腺、杯状细胞、呼吸道上皮细胞和血管内皮细胞。M3受体可以增加腺体分泌，这在副交感神经介导的消化反应中以及在支气管分泌物中都是重要的。
Background:Anticholinergic administration prior to flexible bronchoscopy has been investigated, but studies have not yielded consistent results.Methods:Patients were randomized 1: 1 to receive nebulized 4 ml ipratropium bromide (1 mg, n= 125) or placebo (n= 125) for 15 minutes as premedication, 20 to 40 minutes before bronchoscopy. Airway secretions, bleeding, patient discomfort, procedure time, and procedure-related adverse events were compared between the groups.Results:Nebulized ipratropium bromide prior to bronchoscopy could reduce airway secretions and patient discomfort (P=. 02; P<. 001, respectively), but not tracheobronchial bleeding or procedure time (P=. 51, P=. 36, respectively). Chest nodule or mass was the most common indication for performing bronchoscopy. The adverse events were higher in ipratropium bromide group, and hypertension was the most common complication.Conclusion:Nebulized ipratropium bromide prior to bronchoscopy is a more effective regimen that shows a practical benefit on the airway secretions and patient comfort, though these effects may not translate into any marked reduction in bleeding or of procedure time under general anesthesia. We suggest that routine nebulized ipratropium bromide premedication for bronchoscopy could be useful and beneficial.Trial Registration:chictr. org. cn: ChiCTR1800016881.1 IntroductionFlexible bronchoscopy was introduced into pulmonology 50 years ago.[1] With the development of some technological advances, it has become an invaluable diagnostic tool for many lung disorders and is a safe procedure with low (0.1–2.5%) morbidity and very low (0.05%) mortality.[2] However, the hypersecretion in the trachea and bronchi during general anesthesia makes it hard for bronchoscopist to observe and perform their duties. M3 muscarinic acetylcholine receptors are mainly located in respiratory smooth muscle, submucosal glands, goblet cells, airway epithelial cells, and vascular endothelial cells. The M3 receptor can increase glandular secretions, which is important in the parasympathetic-mediated digestion response as well as in bronchial secretions.[3] Antagonizing M3 receptors can inhibit mucus hypersecretion.