纤维支气管镜检查术患者右美托咪定-瑞芬太尼麻醉的效果

目的评价纤维支气管镜(纤支镜)检查术患者右美托咪定-瑞芬太尼麻醉的效果。方法选择2013年1²月在绵阳市中心医院拟行纤支镜检查术患者40例,采用随机数字表法分为两组。右美托咪定组10 min内静脉泵注右美托咪定1μg/kg后以0.42月在绵阳市中心医院拟行纤支镜检查术患者40例,采用随机数字表法分为两组。右美托咪定组10 min内静脉泵注右美托咪定1μg/kg后以0.4⁰.6μg/(kg·h)泵注维持麻醉,同时静脉泵注瑞芬太尼0.1μg/(kg·h);异丙酚组缓慢静脉注射异丙酚2 mg/kg后以40.6μg/(kg·h)泵注维持麻醉,同时静脉泵注瑞芬太尼0.1μg/(kg·h);异丙酚组缓慢静脉注射异丙酚2 mg/kg后以4⁶ mg/(kg·h)泵注维持麻醉,同时静脉泵注瑞芬太尼0.1μg/(kg·h)。观察两组患者麻醉前(T0)、诱导后即刻(T1)、纤支镜进入声门即刻(T2)、纤支镜抵达隆突即刻(T3)、纤支镜检查完成即刻(T4)的血压、心率、脉搏血氧饱和度及呼吸频率,并记录两组手术时间、镇静评分(OAA/S)、苏醒时的呼吸道痛视觉模拟评分(VAS)、麻醉医师和内镜医师对麻醉效果的满意评分,观察不良反应。结果不同时点的生命体征:T1、T2、T3、T4时点异丙酚组的血压均显著低于右美托咪定组,(P<0.05),T1、T2、T3时点异丙酚组的呼吸频率和脉搏血氧饱和度均显著低于右美托咪定组,(P<0.05),T1、T2时点异丙酚组的心率显著低于右美托咪定组(P<0.05)。OAA/S评分、麻醉医师对麻醉效果满意评分及术中体动和呛咳发生率右美托咪定组显著高于异丙酚组(P<0.05),VAS评分右美托咪定组低于异丙酚组(P<0.05)。结论右美托咪定-瑞芬太尼用于纤支镜检查,麻醉醉效果满意,呼吸抑制少,术后镇痛效果好,值得临床推广。

Anesthesia Effect of Dexmedetomidine Combined with Remifentanil for Fiberoptic Bronchoscopy

Objective To evaluate the anesthesia efficacy of dexmedetomidine combined with remifentanil for fibereptic bronchoscopy. Methods Forty ASA I or II patients who underwent fiberoptic bronchoscopy were randomly divided into two groups with 20 patients each. Group dexmedetomidine was given dexmedetomidine injection for induction （ 1 μg/kg, within 10 minutes） and maintenance 0.4-0.6 μg/（ kg · h ） ], meanwhile the patients were give remifentanil0.1μg/（ kg · h） ] ;group propofol was intravenously injected with propofol for induction （ 2 mg/kg and maintenance 4.6 mg/（ kg · h ） ], meanwhile the patients were given remifentanil0.1 μg/（ kg · h） ]. All patients＇ BP, HR, RR and SPO2 were observed at different time points of before anesthesia（ To ）, immediately after induction（ T1 ）, immediately after brenchoscopy entering glottis（ T2 ）, immediately after brenchoscopy into carina （ T3 ）, and immediately after the broncboscopy completion; operation time, sedation scores （ OAA/S）, VAS score of pain after consciousness and the anesthetic efficacy assessed by anesthetist and endoscoptist were recorded. The adverse reactions were observed. Results Compared with group dexmedetomidine, BP of group prepofol at the time points of T1 , T2, T3 , T4 were significantly lower（ P 〈 0.05 ）. RR and SPO2 of group propofol at the time points of T1 ,T2, T3 were significantly lower than group dcxmedetomidine （P 〈 0.05 ）. HR of group prepofol at the time points of T1 , T2 were significantly lower（ P 〈 0.05 ）. OAA/S score,the anesthetic efficacy of anesthetist and the incidences of intraoperative body movement and cough were significantly higher in group dexmedetomidine than in group propofol（ P 〈 0.05 ）. VAS score of pain after consciousness was significantly lower in group dexmedetomidine than in group propofnl（ P 〈 0.05 ）. Conclusion Dexmedetomidine combined with remifentanil for fibereptic brenchoscopy has satisfactory anesthesia effect, less respiratory inhi