舒芬太尼联合右美托咪定用于重度气管狭窄患者纤维支气管镜诊疗的研究  

Efficacy and safety of sufentanil combined with dexmedetomidine in diagnosis and treatment of severe tracheal stenosis by fiberoptic brouchoscopy

作　　者：安龙 吴玮 段若望[1] 吕欣[1] 刘建明[1] AN Long;WU Wei;DUAN Ruowang;LYU Xin;LIU Jianming(Department of Anesthesiology,Shanghai Pulmonary Hospital,Tongji University,Shanghai 200433,China)

机构地区：[1]同济大学附属上海市肺科医院麻醉科,上海200433

出　　处：《上海医学》2022年第6期406-411,共6页Shanghai Medical Journal

基　　金：上海市卫生健康委员会卫生行业临床研究专项(201940366)。

摘　　要：目的探讨舒芬太尼联合右美托咪定用于重度气管狭窄患者纤维支气管镜诊疗的有效性和安全性。方法选择2021年2-10月在同济大学附属上海市肺科医院接受纤维支气管镜诊疗的重度气管狭窄患者60例,ASA分级为Ⅰ~Ⅲ级。在右美托咪定镇静基础上,对前30例患者采用改良序贯法滴定舒芬太尼以确定其95%效应室浓度(EC95);后30例患者以舒芬太尼的EC95为血浆靶浓度行靶控输注(TCI)评价本方案的安全性。观察呛咳评分,低氧血症的发生率、严重程度以及改善措施。记录操作过程血流动力学变化情况;操作前和操作后15 min时动脉血气分析结果;鼻咽通气管置入耐受评分;Ramsay镇静评分;苏醒时间及相关不良反应等。结果在右美托咪定镇静基础上,舒芬太尼抑制重度气管狭窄患者纤维支气管镜诊疗应激反应的EC95为0.212μg/L(95%CI为0.196~0.287μg/L)。以舒芬太尼的EC95为血浆靶控浓度的30例患者中,29例患者有效抑制应激,有效率96.7%(29/30);1例患者因呛咳影响操作,给予丙泊酚30 mg补救后完成操作。低氧血症发生率26.7%(8/30),其中7例患者通过唤醒恢复正常,1例予面罩辅助通气后恢复正常。与操作前比较,操作后各时间点平均动脉压(MAP)、心率(HR)差异均无统计学意义(P值均>0.05)。与操作前比较,操作后15 min血氧饱和度(SpO_(2))、PaO_(2)、PaCO_(2)均升高(P值均<0.05)。鼻咽通气管置入耐受评分为[1(0,2)]分,Ramsay镇静评分为[3(3,4)]分,呛咳评分为[0(0,1)]分,苏醒时间为[5.0(1.0,10.5)]min。操作结束30 min后鼻咽部疼痛患者3例,无其他相关不良反应发生。结论在右美托咪定镇静基础上,舒芬太尼TCI抑制重度气管狭窄患者纤维支气管镜诊疗应激反应的EC95是0.212μg/L,该方案安全有效。Objective To investigate the efficacy and safety of sufentanil combined with dexmedetomidine in fiberoptic bronchoscopy for the diagnosis and treatment of severe tracheal stenosis.Methods Sixty patients with severe tracheal stenosis who were in ASA grade I-III and underwent selective diagnosis and treatment with fiberoptic bronchoscope from February 2021 to October 2021 in Shanghai Pulmonary Hospital,Tongji University were enrolled in this study.On the basis of dexmedetomidine sedation,the effective concentration of sufentanil was titrated by modified sequential method in the first 30 patients,and 95%effective concentration(EC95)of sufentanil was set as the plasma target concentration in the last 30 patients.The choking score and the incidence,severity and improvement measures of hypoxemia were observed.Hemodynamic changes during the operation,arterial blood gas analysis before and 15 min after operation,nasopharynx airway insertion tolerance score,Ramsay Sedation score,recovery time and related adverse reactions were recorded.Results On the basis of dexmedetomidine sedation,the EC95 of sufentanil inhibiting the stress response was 0.212μg/L in patients with severe tracheal stenosis receiving fiberoptic bronchoscope.The stress was effectively inhibited in 29 of the 30 patients with the EC95 of sufentanil as plasma target concentration,and the effective rate was 96.7%(29/30).The operation was paused for choking in one patient,and completed after giving 30 mg propofol.The incidence of hypoxemia was 26.7%(8/30).Of them,7 patients returned to normal after wake-up and one patient returned to normal after mask assisted ventilation.There was no significant difference in MAP or HR at each time point as compared with that before operation(P>0.05).Compared with those before operation,SpO 2,PaO 2 and PaCO 2 were increased in 15 min after operation(P<0.05).The median tolerance score of nasopharynx airway insertion was(1[0,2]),Ramsay sedation score was(3[3,4]),choking score was 0,and recovery time was(5.0[1.0,10.5])min.There

关 键 词：舒芬太尼 有效浓度 监测下麻醉管理 重度气道狭窄 纤维支气管镜 

分 类 号：R614[医药卫生—麻醉学]