丙泊酚联合右美托咪啶与芬太尼在无痛气管镜检查中的应用价值  

Application value of propofol combined with dexmedetomidine and fentanyl in painless tracheoscopy

作　　者：赵勤峰 吕卫兵 朱晓红 朱跃坤 

机构地区：[1]苏州吴中人民医院呼吸内科,江苏苏州215128

出　　处：《西部医学》2018年第1期77-80,共4页Medical Journal of West China

基　　金：江苏省卫生厅资助项目(201301025)

摘　　要：目的探讨丙泊酚联合右美托咪啶与芬太尼在无痛气管镜检查中的应用价值。方法选取2016年1月~2017年2月收治的实施气管镜检查患者90例,依据患者麻醉方法不同将其分为无痛气管镜组(丙泊酚联合右美托咪啶同时复合芬太尼麻醉)48例及对照组(单一使用丙泊酚麻醉)42例,观察麻醉前后两组血流动力学指标:收缩压(SBP)、舒张压(DBP)、心率(HR)、氧饱和度(SpO_2),并比较两组麻醉效果:起效时间、镇静维持时间、患者依从性、镜检时间、及不良反应发生率。结果 T_0时刻两组SBP、DBP、HR、SpO_2比较无统计学意义(P>0.05);与T_0时刻相比,T_1时刻无痛气管镜组SBP、DBP、HR、SpO_2无明显波动,对照组SBP、DBP有升高、HR加快、SpO_2明显降低,两者相比有统计学意义(P<0.05),而T_2时刻无痛气管镜组SBP、DBP有所降低、HR偏快、SpO_2降低,对照组对应指标较检查前无明显波动,两组相比无统计学意义(P>0.05);无痛气管镜组起效、镜检时间较对照组明显短,但镇痛维持时间较对照组明显长,患者依从性明显提高,差异有统计学意义(P<0.05);麻醉后无痛气管镜组药物不良反应总发生率为31.25%较对照组47.62%明显低(P<0.05)。结论丙泊酚联合右美托咪啶、芬太尼在无痛气管镜检查中的应用较单一麻醉药物的无痛支气管镜检查更具优势,联合药物方案不仅有效稳定患者血流动力学,且可获取最佳麻醉效果,提高依从性,缩短检查时间和较高的药物安全性。Objective To explore the application value of propofol combined with dexmedetomidine and fentanyl in painless tracheoscopy. Methods 90 patients undergoing tracheoscopy in our hospital during January 2016 to February 2017 were selected as subjects. According to different methods of anesthesia, the patients were divided into the painless group （propofol combined with dexmedetomidine and fentanyl anesthesia, n= 48） and the single group （propofol anesthe- sia alone, n=42）. The hemodynamic parameters [systolic pressure （SBP）, diastolic pressure （DBP）, heart rate （HR）, oxygen saturation （SpO2）] in the two groups were observed before and after anesthesia. The anesthetic effects （onset time, duration of analgesia, compliance）, duration of tracheoscopy and the incidence of adverse reactions were compared between the two groups. Results There were no significant differences in SBP, DBP, HR and SpO2 between the two groups at To （P 〉 0.05）. Compared with TO, there were no obvious changes of SBP, DBP, HR and SpO2of the painless group at T1, while in the single group, SBP and DBP increased, HR accelerated, and SpOz decreased significantly （P〈 0.05）. At T2, SBP and DBP decreased, HR accelerated and SpO2 decreased in the painless group while there were no ob- vious changesin the single group （P〉0.05）. The onset time and duration of tracheoscopy in the painless group were sig- nificantly shorter than those in the single group, the duration of analgesia was significantly longer than that in the single group and patients＇ compliance was significantly better than that of the single group （P〈0.05）. The total incidence of adverse drug reactions was lower in the painless group than the single group after anesthesia （31.25% vs 47.62%） （P〈 0.05）. Conclusion The anesthesia with propofol combined with dexmedetomidine and fentanyl has more advantages over single drug anesthesia in painless tracheoscopy. The combined medication can not only effectively stabilize hemodynamics but

关 键 词：无痛气管镜 丙泊酚 右美托咪啶 芬太尼 

分 类 号：R971.2[医药卫生—药品]