右美托咪定与瑞芬太尼复合丙泊酚靶控输注应用于经支气管镜超声引导针吸活组织检查术麻醉效果的比较  

Anesthetic efficacies of dexmedetomidine versus remifentanil combined with propofol target-controlled infusion in endobronchial ultrasound-guided transbronchial needle aspiration

作　　者：朱宏伟[1] 吴镜湘[1] 徐美英[1] 

机构地区：[1]上海交通大学附属胸科医院麻醉科,上海200030

出　　处：《上海医学》2013年第6期490-493,共4页Shanghai Medical Journal

摘　　要：目的比较右美托咪定与瑞芬太尼复合丙泊酚靶控输注(TCI)应用于经支气管镜超声引导针吸活组织检查术(EBUS-TBNA)的麻醉效果。方法将60例行EBUS-TBNA的患者随机分入瑞芬太尼组和右美托咪定组,每组30例,分别先缓慢静脉注射瑞芬太尼或右美托咪定0.5μg/kg,继经微量静脉输液泵分别注射瑞芬太尼0.02μg·kg-1·min-1或右美托咪定0.2μg·kg-1·h-1维持。两组起始TCI质量浓度均为1.5μg/mL,以脑电双频指数40～50为目标调节TCI质量浓度,意识消失后开始手术。在入手术室时(T0)、麻醉后入声门前(T1)、纤维气管镜入声门即刻(T2)、超声探头初次置入即刻(T3)、取活组织时(T4)和术毕即刻(T5)各时间点,记录患者的心率、平均动脉压(MAP)、脉搏血氧饱和度(SpO2)。记录术中患者发生呛咳、躁动、呼吸抑制(呼吸频率<10次/min)、低氧血症(SpO2<90%)、低血压(收缩压<100mmHg,1mmHg=0.133kPa)、高血压[收缩压≥140mmHg和(或)舒张压≥90mmHg]、心动过缓(心率<60次/min)、心动过速(心率>100次/min)的发生率及术后苏醒时间。结果瑞芬太尼组在T1时间点的心率﹑MAP均显著低于同组T0时间点(P值均<0.05),T2至T5时间点的心率﹑MAP及T1至T5时间点的SpO2与同组T0时间点的差异均无统计学意义(P值均>0.05)。右美托咪定组在T1时间点的心率显著慢于同组T0时间点(P<0.05),T2至T5时间点的心率、T1至T5时间点的MAP和SpO2与同组T0时间点的差异均无统计学意义(P值均>0.05)。右美托咪定组在T2时间点的心率显著慢于瑞芬太尼组同时间点(P<0.05),T1至T5时间点的SpO2均显著高于瑞芬太尼组同时间点(P值均<0.05),两组间T0和T3至T5时间点的心率、T0至T5时间点的MAP及T0时间点的SpO2的差异均无统计学意义(P值均>0.05)。右美托咪定组的呛咳发生率显著高于瑞芬太尼组(P<0.05),但呼吸抑制、低氧血症的发生率显著低于瑞芬太尼组(P值均<0.05),两组间其他不良事件�Objective To compare the anesthetic efficacies of dexmedetomidine versus remifentanil combined with propofol target-controlled infusion （TOI） in endobronchial ultrasound-guided transbronchial needle aspiration （EBUS-TBNA）. Methods Sixty patients undergoing EBUS-TBNA were randomly assigned to remifentanil group and dexmedetomidine group （n=30）. In remifentanil group, 0. 5 μg/kg remifentanil was injected slowly, followed by infusion at maintenance dose of 0.02μg·kg^-1·min^-1 In dexmedetomidine group, 0. 5 μg/kg dexmedetomidine was injected within 10 min, followed by infusion at maintenance dose of 0.2 μg·kg^-1·h^-1.The initial concentration of propofol TCI was 1.5 iJg/mL for all patients, which was adjusted by the bispectral index （BIS） 40-50. The operation began until consciousness was lost. Heart rate （HR）, mean arterial pressure （MAP）, and pulse oxygen saturation （SpO2） were recorded before anesthesia （T0）, before the examination after anesthesia （T1）, when bronchoscope passed the glottis point （T2）, when ultrasound probe was inserted （T3）, at biopsy （T4） and after bronchoscope pulled out （T5）. The incidence of adverse events, such as cough, restlessness, respiratory depression （respiratory frequency less than 10/min）, and recovery time were also obtained. Results In remifentanil group, HR and MAP at T1 were significantly lower than those at T0 （both P〈0.05）, but in dexmedetomidine group, only HR at T1 was lower than that at To （P〈0.05）. HR at T2 in dexmedetomidine group was significantly lower than that in remifentanil group （P 〈 0. 05）. SpO2 in dexmedetomidine group was significantly higher than that in remifentanil group from T1 to T5 （all P〈0. 05）. There were no significant differences in terms of HR at T0, T3, T4 and T5, .MAP from T0 to T5, or SpO2 at To between two groups （all P〉0. 05）. The incidence of cough in dexmedetomidine group was significantly higher than that in remifentanil group （P〈0.05）, while th

关 键 词：右美托咪定 瑞芬太尼 丙泊酚靶控输注 经支气管镜超声引导针吸活组织检查术 

分 类 号：R614[医药卫生—麻醉学]