不同剂量阿芬太尼联合Dex在支气管镜检查麻醉中的应用效果与安全性观察  

Observation of the Application Effect and Safety of Different Doses of Fentanyl Combined with Dex in Bronchoscopy Anesthesia

作　　者：王晓群 李东雪 倪文静 WANG Xiaoqun;LI Dongxue;NI Wenjing(Anesthesia Department 2,Tangshan Workers'Hospital,Tangshan 063000,Hebei;Department of Anesthesiology,Fengnan District Traditional Chinese Medicine Hospital,Tangshan,Hebei 063000)

机构地区：[1]唐山市工人医院麻醉二科,河北唐山063000 [2]唐山市丰南区中医医院麻醉科,河北唐山063000

出　　处：《转化医学杂志》2024年第11期2046-2051,2056,共7页Translational Medicine Journal

基　　金：河北省卫生健康委医学科学研究课题(20221803)。

摘　　要：目的探讨不同剂量阿芬太尼联合右美托咪定(Dex)在支气管镜检查麻醉中的应用效果与安全性。方法选取2023年4月至2024年6月在唐山市工人医院行支气管检查患者150例,采用随机数字表法将患者分为A组、B组和C组,每组50例,A组缓慢静脉推注阿芬太尼,剂量10μg/kg,推注时间需超过30 s,2 min后静脉推注丙泊酚,剂量1 mg/kg,随后给予右美托咪定持续输注,剂量范围(0.4~0.8)μg/(kg·h)。B组缓慢静脉推注阿芬太尼5μg/kg,Dex和丙泊酚用法用量同A组。C组仅Dex和丙泊酚持续输注且用法用量同A组。观察比较各组临床资料、不同时间点血流动力学指标、麻醉效果评价、麻醉药物使用量、操作时间、恢复自主呼吸时间、拔除喉罩时间、离开麻醉后监测治疗室时间、支气管镜通过声门时评分、支气管镜通过隆突时评分、不良反应差异。结果A组支气管镜通过声门时(T1)、支气管镜通过隆突(T2)、检查结束(T3)、拔除喉罩(T4)和拔除喉罩后5 min(T5)时平均动脉压(MAP)、心率(HR)高于B组、C组(P<0.05);各组T0、T1、T2、T3、T4及T5时血氧饱和度(Sp O2)和脑电双频指数(BIS)比较差异无统计学意义(P>0.05)。A组和B组麻醉效果评价Ⅰ级比例高于C组(P<0.05)。A组丙泊酚用量明显少于B组和C组(P<0.05)。A组操作时间、恢复自主呼吸时间、拔除喉罩时间和离开麻醉后监测治疗室时间快于B组、C组(P<0.05)。A组支气管镜通过声门时评分、支气管镜通过隆突时评分低于B组、C组(P<0.05)。A组和B组总不良反应发生率明显低于C组(P<0.05)。结论10 g/kg阿芬太尼联合Dex在支气管镜检查麻醉中有较好应用价值,患者血流动力学稳定,术后恢复快,不良反应少。Objective To explore the application effect and safety of different doses of fentanyl combined with dexmedetomidine(Dex)in bronchoscopy anesthesia.Methods 150 patients who underwent bronchial examination in Tangshan Workers'Hospital from April 2023 to June 2024 were selected,the patients were divided into Group A,Group B,and Group C using a random number table method,with 50 cases in each group.Group Group A received slow intravenous injection of fentanyl at a dose of 10μg/kg for more than 30 seconds.Two minutes later,propofol was administered intravenously at a dose of 1mg/kg,followed by continuous infusion of dexmedetomidine at a dose range of(0.4-0.8)μg/(kg·h).Group B received slow intravenous injection of fentanyl at a dose of 5μg/kg,with Dex and propofol used in the same manner as Group A.Group C only received continuous infusion of Dex and propofol,with the same dosage and administration as Group A.The infusion rate was adjusted according to the patient's condition monitored during surgery.Group B received slow intravenous injection of fentanyl at a dose of 5μg/kg,with Dex and propofol used in the same manner as Group A.Group C received Dex and propofol were continuously infused using the same method as Group A.The clinical data,hemodynamic indicators at different time points,evaluation of anesthesia effectiveness,dosage of anesthetic drugs,operation time,time to restore spontaneous breathing,time to remove laryngeal mask,time to leave the anesthesia monitoring treatment room,bronchoscopy passing through the glottis score,bronchoscopy passing through the prominence score,and differences in adverse reactions among different groups were observed and compared.Results The mean arterial pressure(MAP)and heart rate(HR)of group A were higher than those of group B and C at the time of bronchoscopy passing through the glottis(T1),bronchoscopy passing through the protuberance(T2),end of examination(T3),removal of laryngeal mask(T4),and 5 minutes after removal of laryngeal mask(T5)(P<0.05).There was no statistica

关 键 词：阿芬太尼 右美托咪定 支气管镜检查 麻醉效果 

分 类 号：R614.2[医药卫生—麻醉学]