右美托咪定预镇静对无痛支气管镜检查不良反应发生率的影响  

The Effect of Dexmedetomidine on the Incidence of Adverse Reactions in Painless Bronchoscopy

作　　者：杨仁[1] 温海明[1] 何婉雯 孔德煜 肖泽林[1] 谢艺开[1] 罗玮[1] 马志明[1] 盛青[1] YANG Ren;WEN Haiming;HE Wanwen;KONG Deyu;XIAO Zelin;XIE Yikai;LUO Wei;MA Zhiming;SHENG Qing(GuangzhouChest Hospital,Guangzhou 510095,China;不详)

机构地区：[1]广州市胸科医院,广东广州510095

出　　处：《现代医院》2020年第10期1522-1524,1531,共4页Modern Hospitals

基　　金：广东省医学科学技术研究基金(A2020183)。

摘　　要：目的观察右美托咪定(dexmedetomeidine,Dex)预镇静对瑞芬太尼复合丙泊酚用于无痛支气管检查的不良反应发生率。方法选择需要支气管镜检患者70例,随机分为观察组和对照组,每组35例。观察组:麻醉前右美托咪定镇静后开始麻醉维持(利多卡因+瑞芬太尼+丙泊酚);对照组:麻醉前不使用右美托咪定镇静,麻醉维持方法与观察组相同。对2组患者记录以下指标:①入室时(T0)、麻醉诱导结束时(T1)、过声门时(T2)、到达隆突时(T3)、术毕5 min(T4)各时点心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO2)变化;②麻醉药用量、麻醉时间、检查和苏醒时间;③低氧血症、呛咳、体动、高血压和心律失常发生率;④患者满意度满意度评价。结果①在T1时点,2组患者的心率减慢、血压均降低;与T0比较均有显著性差异(P <0.05);在T2时点,对照组的心率增快,与本组T0及观察组T2比较均有显著性差异(P <0.05);T2时点对照组的血压与T0比较升高(P <0.05);2组均未出现低氧血症。②观察组丙泊酚、瑞芬太尼均少于对照组差异有显著性丙泊酚(P <0.01),瑞芬太尼(P <0.05);观察组复苏时间为(2.6±1.5 min)、对照组(2.7±1.7 min)组间比较无差异(P>0.05)。③对照组患者呛咳、体动发生率分别为28.6%、20%高于观察组的17.1%、8.5%均有显著性差异(P <0.01)。④2组患者评价均为舒适。结论瑞芬太尼复合丙泊酚加用Dex预镇静能更好维护循环稳定,减少患者呛咳和躁动;内窥镜面罩等有效呼吸道管理有利于避免低氧血症发生。Objective To observe the effect of dexmedetomidine( DEX) on the anesthetic effect of remifentanil combined with propofol in painless bronchoscopy. Methods 70 patients who needed bronchoscopy were randomly divided into two groups: the observation group and the control group with 35 cases in each group. In the observation group,before anesthesia,dexmedetomidine was used and then began to maintain anesthesia( lidocaine + remifentanil + propofol);in the control group,dexmedetomidine was not used for sedation before anesthesia,and the method of maintaining anesthesia was the same as that in the observation group. The following indexes were recorded in the two groups:(1) the changes of HR,mean arterial pressure( MAP) and SpO2 when entering the room( T0),the end of anesthesia induction( T1),the time of passing through the glottis( T2),the time of reaching the bulge( T3) and the time of 5 minutes after operation( T4),respectively.(2) Anesthetic dosage,anesthesia time,examination and recovery time.(3) Incidence of hypoxemia,bucking,restlessness,hypertension and arrhythmia.(4)Satisfaction evaluation from both the patients and the bronchoscopy operators. Results(1) At T1,the heart rate and blood pressure in the two groups decreased,in which there were significant differences compared with those in T0( P < 0. 05);At T2,the heart rate of the control group increased,in which a significant differences were found compared with those at T0 in the control group and T2 in the observation group( All P < 0. 05);At T2,the blood pressure of the control group increased compared with that at T0( P < 0. 05) and there was no hypoxemia in both groups.(2)The anesthetic dosages of both propofol and remifentanil in the observation group were less than those in the control group,in which the significant differences were found in propofol( P < 0. 01),remifentanil( P < 0. 05),respectively;the recovery time of the observation group was( 2. 6 ± 1. 5 min),the control group( 2. 7 ± 1. 7 min),without difference between the groups( P >0. 05).(3) The

关 键 词：右美托咪定 瑞芬太尼 丙泊酚 支气管镜 

分 类 号：R614.24[医药卫生—麻醉学]