咪达唑仑复合芬太尼对全胸腔镜肺叶切除术治疗支气管扩张症患者血氧饱和度及血流动力学的影响  

Effects of midazolam combined with fentanyl on blood oxygen saturation and hemodynamics in bronchiectasis patients undergoing total thoracoscopic lobectomy

作　　者：郎捷[1] 杨瑞东 刘泽宇 李文奇 邢树山 Lang Jie;Yang Ruidong;Liu Zeyu;Li Wenqi;Xing Shushan(Department of Thoracic Surgery,Tangshan People's Hospital,Hebei Province,Tangshan 063000,China;Department of Pathology,Luanzhou People's Hospital,Hebei Province,Tangshan 063700,China;Department of Oncology,Tangshan Central Hospital,Hebei Province,Tangshan 063000,China)

机构地区：[1]河北省唐山市人民医院胸外科,063000 [2]滦州市人民医院病理科,河北省唐山市063700 [3]河北省唐山市中心医院肿瘤科,063000

出　　处：《中国医药》2021年第11期1664-1668,共5页China Medicine

基　　金：河北省卫生健康委员会医学科学研究课题计划(20191613)。

摘　　要：目的研究咪达唑仑复合芬太尼对全胸腔镜肺叶切除术治疗支气管扩张症患者血氧饱和度及血流动力学的影响。方法选取2019年3月至2020年3月于唐山市人民医院行全胸腔镜肺叶切除术治疗的140例支气管扩张症患者,按随机数字表法分为对照组和观察组,各70例。对照组静脉推注芬太尼麻醉;观察组静脉推注咪达唑仑联合芬太尼麻醉。比较2组不同时点[麻醉前(T_(0))、麻醉后切皮前(T_(1))、切皮后1 h(T_(2))、手术结束(T_(3))]的血氧饱和度(SpO_(2))、血流动力学指标(舒张压、收缩压、心率),以及术后不同时点[T_(3)、术后2 h(T_(4))、术后24 h(T_(5))、术后48 h(T_(6))]的疼痛视觉模拟量表(VAS)评分和应激指标[丙二醛、超氧化物歧化酶(SOD)]水平、围术期指标(胸腔引流管放置时间、恢复清醒时间与住院时间),记录2组术后并发症发生情况。结果观察组T_(1)、T_(2)、T_(3)时点SpO_(2)、舒张压、收缩压水平均高于对照组,心率水平低于对照组(均P<0.05)。观察组T_(4)、T_(5)、T_(6)时点VAS评分均低于对照组(均P<0.05)。T_(4)时点观察组丙二醛水平低于对照组,SOD水平高于对照组,差异均有统计学意义(均P<0.05)。观察组患者恢复清醒时间、住院时间均短于对照组[(2.4±1.2)min比(4.8±2.6)min、(9.4±2.0)d比(11.5±3.2)d],差异均有统计学意义(均P<0.001);但2组胸腔引流管放置时间比较,差异无统计学意义(P=0.792)。对照组与观察组并发症发生率比较[11.4%(8/70)比7.1%(5/70)],差异无统计学意义(P=0.382)。结论对全胸腔镜肺叶切除术治疗支气管扩张症患者应用咪达唑仑复合芬太尼麻醉,可减轻对呼吸循环系统抑制作用,稳定血流动力学,降低应激反应,且患者术后清醒快,住院时间短。Objective To study the effects of midazolam combined with fentanyl on blood oxygen saturation(SpO_(2))and hemodynamics in bronchiectasis patients undergoing total thoracoscopic lobectomy.Methods A total of 140 bronchiectasis patients undergoing total thoracoscopic lobectomy in Tangshan People’s Hospital from March2019 to March 2020 were enrolled.They were randomly divided into control group and observation group,with 70 cases in each group.The control group was given fentanyl intravenous injection anesthesia,and the observation group was given midazolam combined with fentanyl intravenous injection anesthesia.SpO_(2) and hemodynamics indexes[diastolic blood pressure(DBP),systolic blood pressure(SBP),heart rate]at different time points[before anesthesia(T_(0)),before skin incision(T_(1)),1 h after skin incision(T_(2)),end of surgery(T_(3))],scores of pain visual analogue scale(VAS)score and levels of stress indexes[malondialdehyde(MDA),superoxide dismutase(SOD)]after surgery[T_(3),2 h after surgery(T_(4)),24 h after surgery(T_(5)),48 h after surgery(T_(6))],and perioperative indexes(time of chest drainage tube placement,awaking time,length of stay)were compared between the two groups.The occurrence of postoperative complications in both groups was recorded.Results The levels of SpO_(2),DBP and SBP in the observation group at T_(1),T_(2)and T_(3)time points were higher than those in control group,and heart rate in observation was lower than that in control group(all P<0.05).VAS scores in observation group at T_(4),T_(5)and T_(6)time points were lower than those in control group(all P<0.05).At T_(4)time point,the level of MDA in observation group was lower than that in control group,and the level of SOD in observation group was higher than that in control group(both P<0.05).The awaking time and length of stay in observation group were shorter than those in control group[(2.4±1.2)min vs(4.8±2.6)min,(9.4±2.0)d vs(11.5±3.2)d](both P<0.001).However,there was no significant difference in the time of thoracic drainag

关 键 词：支气管扩张症 咪达唑仑 芬太尼 全胸腔镜肺叶切除术 血流动力学 

分 类 号：R655.3[医药卫生—外科学]