右美托咪定或丙泊酚复合芬太尼用于无痛纤维支气管镜检查效果比较  

Comparison of dexmedetomidine or propofol combined with fentanyl in painless fiberoptic bronchoscopy

作　　者：张宁[1] 程燕[2] 郝继英[1] 李治国[3] 

机构地区：[1]冀中能源峰峰集团总医院麻醉科,河北邯郸056200 [2]冀中能源峰峰集团总医院输血科,河北邯郸056200 [3]冀中能源峰峰集团总医院骨科,河北邯郸056200

出　　处：《河北医科大学学报》2017年第4期428-432,共5页Journal of Hebei Medical University

基　　金：邯郸市科学技术研究与发展计划(1623208065-3)

摘　　要：目的观察右美托咪定复合芬太尼用于无痛纤维支气管镜检查的效果。方法选择择期全身麻醉纤维支气管镜检查的患者60例,随机分为2组:右美托咪定复合芬太尼组(D组),丙泊酚复合芬太尼组(P组),每组30例。2组麻醉诱导前均给予芬太尼1μg/kg。麻醉诱导时D组给予负荷剂量右美托咪定1μg/kg静脉泵注15min,随后以0.4μg·kg^(-1)·h^(-1)维持至检查结束;P组丙泊酚效应室靶浓度为4mg/L,随后调整丙泊酚效应室靶浓度至2~3mg/L。分别于入室时(T_0)、麻醉诱导后(T_1)、纤维支气管镜进入声门时(T_2)、到达隆突时(T_3)、检查完成时(T_4)记录平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、血氧饱和度(oxygen saturation,SpO_2)和警觉镇静(Observer Assessment of Alertness/Sedation,OAA/S)评分,记录检查时间、苏醒时间,以及低氧血症、心血管事件、恶心呕吐、反流误吸等不良反应发生情况。结果 2组OAA/S评分在T_1时明显降低,随后上升再逐渐降低,2组OAA/S评分时点间差异有统计学意义(P<0.05),组间、组间·时点间交互作用差异无统计学意义(P>0.05);2组MAP、HR和SpO_2均在T_1~T_3逐渐降低,在T_4稍升高,2组组间、时点间和组间·时点间交互作用差异均有统计学意义(P<0.05)。D组苏醒时间明显长于P组,D组低氧血症发生率明显低于P组(P<0.05)。2组麻醉效果和支气管镜检查时间差异无统计学意义,且均未出现恶心呕吐、反流误吸等不良反应。结论右美托咪定复合芬太尼用于无痛纤维支气管镜检查可保证良好的镇静镇痛作用,提供更加稳定的血流动力学,并且降低不良反应发生率。Objective To investigate the effect of dexmedetomidine or propofol combined with fentanyl in patients with fiberoptic bronchoscopy.Methods Sixty patients undergoing selective general anesthesia fiberoptic bronchoscopy were randomly divided into two groups(n=30each):dexmedetomidine group(D group)and propofol group(P group).Before induction of anesthesia,patients in both groups received an infusion dose of 1μg/kg fentanyl.Thereafter,in group D,a loading dose of dexmedetomidine 1μg/kg was injected at 15 min before induction of anesthesia,followed by infusion at 0.4μg·kg^(-1)·h^(-1) until the end of fiberoptic bronchoscopy.In group P,the initial effect-site target for propofol concentration was 4mg/L.Subsequently,the concentration of propofol was maintained at a level between 2and 3mg/L.mean arterial pressure(MAP),heart rate(HR),oxygen saturation(SpO_2)and Observer Assessment of Alertness/Sedation(OAA/S)score were recorded at baseline(T_0),immediately after induction(T_1),when the tip of fiberoptic bronchoscopy reached the glottis(T2)and carina(T_3),at the end of bronchoscopy(T_4).The duration of bronchoscopy,emergence time,anesthesia effect,adverse cardiovascular events and side effects such as hyoxemia,nausea and vomiting,regurgitation and aspiration were recorded.Results The OAA/S score of two groups were obviously decreased at T_1 time point,increased gradually and then decreased again.The difference in OAA/S score time dissimilarity in the two groups at the groups and time points were statistically significant(P<0.05).However,there was no significant difference in the interblock and interaction between group and time(P>0.05).The MAP,HR and SpO_2 of two groups were gradually lower at T_1-T_3 time point,and then gradually incredsed at T_4 time point.In MAP,HR and SpO_2,interblock、time dissimilarity and interaction of interblock with time dissimilarity of the two groups had statistically significant difference.Compared with group P,the recover time significantly longer(P<0.05),the incidence hypoxemia was sig

关 键 词：支气管镜 右美托咪定 芬太尼 丙泊酚 

分 类 号：R413.8[医药卫生—临床医学]