胸外科患者术后纤维支气管镜吸痰镇静的随机双盲对照研究  

A double-blinded randomized control trial for conscious sedation in post thoracic surgery patients undergoing flexible bronchoscopy suction sputum

作　　者：祝敏芳[1] 余开颜[1] 潘雁[2] 杨敏[1] ZHU Min-fang;YU Kai-yan;PAN Yan;YANG Min(Intensive Care Unit,Shanghai Chest Hospital,Shanghai Jiao Tong University,Shanghai 200030,China;Pharmacy Department,Shanghai Chest Hospital,Shanghai Jiao Tong University,Shanghai 200030,China)

机构地区：[1]上海交通大学附属胸科医院重症监护科,上海200030 [2]上海交通大学附属胸科医院药剂科,上海200030

出　　处：《上海交通大学学报（医学版）》2018年第11期1343-1348,共6页Journal of Shanghai Jiao tong University:Medical Science

基　　金：上海市胸科医院科技发展基金(YZ13-39)~~

摘　　要：目的·比较丙泊酚和右美托咪定用于胸外科患者术后纤维支气管镜吸痰时镇静的效果及安全性。方法·将90例胸外科术后需行纤维支气管镜吸痰的患者随机分为3组,即对照组、丙泊酚组和右美托咪定组(简称右美组)。对照组予以生理盐水静脉推注;丙泊酚组予以1%丙泊酚0.4 mg/kg静脉推注后,1～2 mg/(kg·h)静脉微泵维持;右美组予以右美托咪定1μg/kg静脉推注后,0.6μg/(kg·h)静脉微泵维持。收集并记录患者用药前、吸痰前、吸痰中、吸痰后即刻、吸痰后0.5 h、吸痰后1 h各个时间点的生命体征及Ramsay评分,评估进声门时插气管镜的难易程度、吸痰时的不良反应并记录患者可视化痛苦评分等,对上述指标进行比较分析。结果·与右美组相比,对照组及丙泊酚组患者于吸痰前后的心率、平均动脉压均明显上升(均P<0.05);而与对照组相比,丙泊酚组患者仅在吸痰前、吸痰后即刻表现为平均动脉压下降(均P<0.05)。与对照组相比,丙泊酚组患者于吸痰前、吸痰中的Ramsay评分均较高(P=0.026,P=0.026),而右美组患者于吸痰前、吸痰后0.5 h、吸痰后1 h的Ramsay评分也均较高(P=0.015,P=0.000,P=0.000)。与对照组相比,右美组患者的不良反应发生率明显下降(P=0.004)。可视化痛苦评分中丙泊酚组得分最低,对照组得分最高。结论·右美托咪定与丙泊酚均能用于纤维支气管镜吸痰镇静,而使用丙泊酚的患者感觉更为舒适。与丙泊酚相比,使用右美托咪定的患者不良反应发生率较低且吸痰时心率、血压更平稳,该药物可能更适合用于合并有心血管疾病的患者。Objective · To compare the effcacy and safety of propofol and dexmedetomidine in conscious sedation in post thoracic surgery patients undergoing flexible bronchoscopy suction sputum. Methods · A total of 90 post thoracic surgery patients who would receive suctioning sputum by fberoptic bronchoscope were randomly divided into three groups, i.e. control group, propofol group, and dexmedetomidine group. The control group received intravenous injection of saline. A bolus dose of 1% propofol （0.4 mg/kg） followed by a 1-2 mg/（kg · h） continuous injection was applied in the propofol group. In the dexmedetomidine group, a bolus dose of dexmedetomidine （1 μg/kg） intravenously injected, followed by a 0.6 μg/（kg · h） continuous injection. The vital signs and Ramsay score were recorded before taking drugs, before sucking sputum, sucking sputum, sucking sputum immediately, 0.5 h after sucking sputum, and 1 h after sucking sputum. Diffculty in entering glottis, adverse events, and visual pain score were also recorded and compared. Results · Compared with the dexmedetomidine group, the heart rate and mean arterial pressure in the propofol group and the control group were higher before and after fexible bronchoscopy suction sputum （all P〈0.05）. Compared with the control group, the mean arterial pressure in the propofol group was lower before sucking sputum and sucking sputum immediately （both P〈0.05）. Compared with the control group, Ramsay sore in propofol group was higher before sucking sputum and sucking sputum （P=0.026, P=0.026）, and Ramsay score in the dexmedetomidine group was higher before sucking sputum, 0.5 h after sucking sputum and 1 h after sucking sputum （P=0.015, P=0.000, P=0.000）. The incidence of adverse events was lower in the dexmedetomidine group than that in the control group （P=0.004）. The visual pain score was lowest in the propofol group and highest in the control group. Conclusion · Both dexmedetomidine and propofol can be used in conscious sedation dur

关 键 词：纤维支气管镜 吸痰 清醒镇静 右美托咪定 丙泊酚 

分 类 号：R453.9[医药卫生—治疗学]