丙泊酚、咪唑安定和芬太尼应用于纤维支气管镜检查的研究  

Study of application of propofol,midazolam and fentanyl to examination of fibrobronchoscopy

作　　者：胡德[1] 李煊[1] 金晓燕[2] 

机构地区：[1]上海市长宁区中心医院麻醉科,上海200336 [2]上海市长宁区中心医院呼吸科,上海200336

出　　处：《中国内镜杂志》2008年第1期70-72,共3页China Journal of Endoscopy

摘　　要：目的探讨丙泊酚联合咪唑安定、芬太尼用于纤维支气管镜(纤支镜Fb)检查的麻醉方法。方法行纤支镜检查患者60例,ASAⅠ～Ⅲ级,随机分为3组,每组20例。全部患者表面麻醉后静脉注入咪唑安定0.02mg/kg、芬太尼1μg/kg,组Ⅰ、组Ⅱ诱导剂量丙泊酚1.0～2.0mg/kg静脉注射后,组Ⅰ连接TE-311微泵以丙泊酚30～75μg/(kg·min)维持,组Ⅱ必要时追加丙泊酚1.0～2.0mg/kg,组Ⅲ为对照组,仅用表面麻醉。记录镜检前后各组的平均动脉压(MAP)、心率(HR)和血氧饱和度(SpO2)的变化。观察插管中患者的镇静程度、一次插管成功率、呼吸抑制、咳嗽、心律失常及躁动发生等情况。结果组Ⅲ患者与组Ⅰ、组Ⅱ相比,HR显著增快,MAP显著增高,SpO2显著下降(P<0.01);组Ⅱ与组Ⅰ相比,HR增快、MAP增高(P<0.05)。组Ⅲ有2例由于剧烈呛咳、咳嗽、憋气导致检查中断。结论丙泊酚联合咪唑安定、芬太尼用于纤支镜检查,血流动力学稳定,是一种比较安全的麻醉方法。[Objective] To explore a combination anesthesia method of propofol, midazolam and fentanyl in the examination of fibrobroncoscopy（Fb）. [Methods] 60 cases of patients, ASA Ⅰ-Ⅲ, accepted Fb examination. All the patients were randomly assigned into three groups, each with 20 cases. All the patients accepted superficial anesthesia followed by intravenous infusion of midazolam 0.02 mg/kg and fentany 1 μg/kg. Groups Ⅰ and Ⅱ were given propofol 1.0-2.0 mg/kg intravenously as a induction dosage. Then in group I the propofol was infused connecting to TE-311 mieropump to maintain a propofol dosage of 30-75 μg/（kg·min）. In group Ⅱ, the propofol was infused manually, with additional dosage of 1.0-2.0 mg/kg in necessity. Group Ⅲ was allocated as control group in which all the cases only accepted superficial anesthesia. The change of the mean artery pressure（MAP）, heart rate（HR）, satsaturation of arterial blood oxygen（SpO2） were recorded before and after Fb examination. Sedation of patient during the examination, one-tlme intubation succeeding rate, and the occurance of respiratory depression, arrhythmia and rest- lesseness were observed. [Results] The patients in group Ⅲ showed higher HR and MAP, lowerer SpO2 compared with those in group Ⅰ and Ⅱ （P〈0.01）. The patients in group Ⅱ had higher HR and MAP, compared with those in group Ⅰ（P 〈0.05）. Two cases in group Ⅲ failed in Fb examination due to severe bucking, eouge and breath holding when fiberscope arrived glottis. [ Conclusions] The combination anesthesia method of propofol, midazolam and fentanyl is greatly helpful in the achievement of fibrobroncoscopy with the advantage of stable haemodynamic change. This is a kind of safe general anesthesia.

关 键 词：丙泊酚 咪唑安定 芬太尼 麻醉 纤维支气管镜 

分 类 号：R562.2[医药卫生—呼吸系统] R614.24[医药卫生—内科学]