右美托咪定联合丙泊酚、瑞芬太尼在老年慢性阻塞性肺疾病患者纤维支气管镜检查中的效果观察  

Application of dexmedetomidine combined with propofol and remifentanil in fiberbronchoscopy in elderly patients with chronic obstructive pulmonary disease

作　　者：钟晓英 王定坤 Zhong Xiaoying;Wang Dingkun(Department of Anesthesiology,the Affiliated Hospital of Medical College of Ningbo University,Ningbo,Zhejiang 315000,China;Department of Clinical Medicine,College of Science and Technology,Jiangxi University of Traditional Chinese Medicine,Nanchang,Jiangxi 330004,China)

机构地区：[1]宁波大学医学院附属医院麻醉科,315000 [2]江西中医药大学科技学院临床医学系,南昌330004

出　　处：《中国基层医药》2020年第22期2763-2767,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨右美托咪定联合丙泊酚、瑞芬太尼在老年慢性阻塞性肺疾病(COPD)患者纤维支气管镜检查中的应用效果。方法选取宁波大学医学院附属医院2018年10月至2019年11月行纤维支气管镜检查的老年COPD患者112例,采用随机数字表法分为对照组、观察组各56例,两组麻醉诱导均采用丙泊酚、瑞芬太尼,观察组静脉注射右美托咪定(0.5μg/kg,之后0.5μg·kg^-1·h^-1持续输注),对照组给予同等剂量0.9%氯化钠注射液。比较两组不同时间改良镇静(OAA/S)评分,丙泊酚用量、瑞芬太尼用量、苏醒时间、心率、血氧饱和度、平均动脉压、肺功能[第一秒用力呼气容积(FEV1)、每分钟最大通气量(MVV)]的变化及不良反应发生率。结果观察组纤维支气管镜进入即刻、检查完成后10 min的OAA/S评分分别为(1.03±0.35)分、(4.42±0.28)分,对照组分别为(1.22±0.22)分、(3.01±0.22)分,两组差异均有统计学意义(t=3.439、29.631,均P<0.05);观察组丙泊酚用量、瑞芬太尼用量分别为(3.00±0.28)μg/kg、(1.65±0.29)μg/kg,均少于对照组的(3.70±0.39)μg/kg、(2.42±0.45)μg/kg,苏醒时间为(8.40±1.58)min,短于对照组的(13.31±2.02)min,差异均有统计学意义(t=10.911、10.763、14.327,均P<0.05);观察组心率、血氧饱和度、平均动脉压、FEV1、MVV指标均显著优于对照组(t=9.757、11.981、11.486、11.913、40.189,均P<0.05);观察组不良反应发生率为7.14%(4/56),低于对照组的19.64%(11/56)(χ^2=6.737,P<0.05)。结论老年COPD患者行纤维支气管镜检查予以右美托咪定,同时靶控输注丙泊酚、瑞芬太尼,其安全性高,麻醉药物使用剂量较小,可缩短术后苏醒时间,且不会对呼吸、循环等产生较大影响。Objective To investigate the application effect of dexmedetomidine combined with propofol and remifentanil in fiberoptic bronchoscopy in elderly patients with chronic obstructive pulmonary disease(COPD).Methods From October 2018 to November 2019,112 elderly patients with COPD who were examined by fiberoptic bronchoscopy in the Affiliated Hospital of Medical College of Ningbo University were divided into control group and observation group,with 56 cases in each group.Propofol and remifentanil were used for anesthesia induction in both two groups.Dexmedetomidine(0.5μg/kg)was injected intravenously into observation group,and later 0.5μg·kg^-1·h^-1 continuous infusion,the control group was given the same dose of 0.9%sodium chloride injection.The OAA/S scores,propofol dosage,remifentanil dosage,wake-up time,heart rate,oxygen saturation,mean arterial pressure,pulmonary function changes and adverse reactions were compared between the two groups.Results At the fiberbronchoscope entered immediately and 10 min after examination,the OAA/S scores in the observation group were(1.03±0.35)points,(4.42±0.28)points,respectively,which in the control group were(1.22±0.22)points,(3.01±0.22)points,respectively,the differences between the two groups were statistically significant(t=3.439,29.631,all P<0.05).The dosages of propofol and remifentanil in the observation group were(3.00±0.28)μg/kg and(1.65±0.29)μg/kg,respectively,which were less than those in the control group[(3.70±0.39)μg/kg,(2.42±0.45)μg/kg],the recovery time was(8.40±1.58)min,which was shorter than that in the control group[(13.31±2.02)min],the differences were statistically significant(t=10.911,10.763,14.327,all P<0.05).The heart rate,oxygen saturation,mean arterial pressure,pulmonary function(FEV1,MVV)in the observation group were significantly better than those in the control group(t=9.757,11.981,11.486,11.913,40.189,all P<0.05).The incidence of adverse reactions in the observation group was 7.14%(4/56),which was lower than 19.64%(11/56)in the contr

关 键 词：麻醉和镇痛 麻醉药 联用 右美托咪定 丙泊酚 瑞芬太尼 肺疾病 慢性阻塞性 支气管镜检查 

分 类 号：R614[医药卫生—麻醉学]