瑞马唑仑-阿芬太尼-米库氯铵用于纤维支气管镜检查术的效果  

Efficacy of remimazolam-alfentanil-mivacurium for fiberoptic bronchoscopy

作　　者：渠明翠 张彤彤 邢飞 李艳娜[1] 李平乐[1] 邢娜[1] Qu Mingcui;Zhang Tongtong;Xing Fei;Li Yanna;Li Pingle;Xing Na(Department of Anesthesiology and Perioperative Medicine,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院麻醉与围术期医学部,450000

出　　处：《中华麻醉学杂志》2021年第5期563-566,共4页Chinese Journal of Anesthesiology

基　　金：河南省医学适宜技术推广项目(SYJS2020114)。

摘　　要：目的:评价瑞马唑仑-阿芬太尼-米库氯铵用于纤维支气管镜检查术的效果。方法:择期行纤维支气管镜检查术患者100例,性别不限,年龄18~64岁,BMI 18.5~28.0 kg/m^(2),ASA分级Ⅰ~Ⅲ级。采用随机数字表法分为2组(n=50):瑞马唑仑-阿芬太尼-米库氯铵组(R组)和丙泊酚-阿芬太尼-米库氯铵组(P组)。采用面罩吸氧,预先缓慢静脉注射阿芬太尼10μg/kg,1 min后R组静脉注射瑞马唑仑0.2 mg/kg,P组注射丙泊酚1.5~2.0 mg/kg,直至意识消失后,2组均注射米库氯铵0.14 mg/kg,BIS值40~60时,由同一名麻醉医生置入喉罩后机械通气。维持期间R组静脉输注瑞马唑仑1 mg·kg^(-1)·h^(-1),P组静脉输注丙泊酚4~6 mg·kg^(-1)·h^(-1),间断注射米库氯铵维持肌松。于诱导前(T_(0))、置入喉罩时(T_(1))、纤维支气管镜抵达隆突即刻(T_(2))、手术开始10 min(T_(3))、手术结束(T_(4))和患者清醒(T_(5))时记录BP、HR、SpO_(2)、P ETCO_(2)、BIS值和改良警觉/镇静评分(MOAA/S评分)。记录麻醉开始至检查开始时间、总检查时间、给药结束至拔除喉罩的时间、恢复自主呼吸时间、患者苏醒至离开PACU时间。记录术中及术后不良反应的发生情况。结果:2组患者各时点SpO_(2)、P ETCO_(2)、BIS值、MOAA/S评分、麻醉开始至检查开始时间、恢复自主呼吸时间和患者苏醒至离开PACU时间比较差异无统计学意义(P>0.05)。与P组比较,R组T_(1)、T_(3)和T_(4)时收缩压和舒张压升高,给药结束至拔除喉罩时间延长,术中低血压、术后咳嗽及总不良反应发生率降低(P<0.05)。结论:瑞马唑仑-阿芬太尼-米库氯铵用于纤维支气管镜检查术的效果优于丙泊酚-阿芬太尼-米库氯铵。Objective To evaluate the efficacy of remimazolam-alfentanil-mivacurium for fiberoptic bronchoscopy.Methods A total of 100 patients of both sexes,aged 18-64 yr,with body mass index of 18.5-28.0 kg/m^(2),of American Society of Anesthesiologists physical statusⅠ-Ⅲ,scheduled for elective fiberoptic bronchoscopy,were divided into 2 groups(n=50 each)using a random number table method:remimazolam-alfentanil-mivacurium group(group R)and propofol-alfentanil-mivacurium group(group P).Oxygen was inhaled by mask,and alfentanil 10μg/kg was slowly injected intravenously in advance.One minute later,remimazolam 0.2 mg/kg was injected intravenously in group R,propofol 1.5-2.0 mg/kg was injected in group P until loss of consciousness,and mivacurium 0.14 mg/kg was then injected intravenously in 2 groups.When the bispectral index value was 40-60,mechanical ventilation was performed after laryngeal mask was placed by the same anesthesiologist.During the maintenance of anesthesia,remimazolam 1 mg·kg^(-1)·h^(-1)was infused intravenously in group R,propofol 4-6 mg·kg^(-1)·h^(-1)was infused intravenously in group P,and mivacurium was intermittently injected in both groups to maintain muscle relaxation.Before induction(T_(0)),when the laryngeal mask was placed(T_(1)),immediately when fiber bronchoscope reached juga(T_(2)),at 10 min after the surgery(T_(3)),at the end of the surgery(T_(4))and when patients regained consciousness(T_(5)),blood pressure(BP),(HR),pulse oxygen saturation(SpO_(2)),breathing at the end of the CO_(2)partial pressure(PETCO_(2)),BIS values and Modified Observer's Assessment/Alertness and Sedation(MOAA/S)score were recorded.The time from beginning of anesthesia to beginning of examination,total examination time,the time from the end of administration to laryngal mask airway removal,the time to recovery of spontaneous breathing and the time from emergence to discharge from postanesthesia care unit(PACU)were recorded.The occurrence of intraoperative and postoperative adverse reactions was recorded.Results T

关 键 词：瑞马唑仑 阿芬太尼 纤维支气管镜检查 

分 类 号：R614[医药卫生—麻醉学]