丙泊酚与依托咪酯乳剂在颅脑损伤合并肺部感染患者纤维支气管镜治疗中的镇静效果及安全性评估

目的 观察丙泊酚与依托咪酯乳剂在颅脑损伤合并肺部感染患者纤维支气管镜治疗中的镇静效果及安全性。方法 选取河北医科大学第二医院2019年1月一2021年8月收治的重症医学科（ICU）机械通气颅脑损伤合并肺部感染患者84例为研究对象，按照用药方案不同分为丙泊酚组和依托咪酯组，每组各42例。两组均给予纤维支气管镜治疗，丙泊酚组给予丙泊酚乳状注射液1~2 mg·kg^-1，人工缓慢静推3~5 min。依托咪酯组给予依托咪酯中/长链脂肪乳注射液0.2~0.4 mg·kg^-1，缓慢静推。操作中若患者躁动明显或呛咳剧烈影响进境，或气管壁出血，则追加丙泊酚30mg或依托咪酯6mg。比较两组给药前5 min （T₀）、给药后-入镜即刻（T₁）、入镜后3 min （T₂）、入镜后10 min （T₃）、撤镜即刻（T₄）、术毕5 min （T₅）时脑电双频谱指数（BIS）、心率（HR）、呼吸频率（RR）、平均动脉压（MAP）、血氧饱和度（SpO₂）、脑氧饱和度（rSO₂）差异，比较两组药物平均使用量、追加药物次数、麻醉起效时间、不良反应发生情况及纤维支气管镜操作医生对镇静效果的满意度。结果 T₁、T₄、T₅时两组BIS均低于本组T₀时，T₂、T₃时高于本组T₁时（P<0.05）；T₀、T₂、T₄、T₅时两组BIS差异无统计学意义（P>0.05）；T₁、T₃时丙泊酚组BIS低于依托咪酯组（P<0.05）；T₁、T₂、T₃、T₄时丙泊酚组HR、MAP低于依托咪酯组（P<0.05）；T₀、T₅时两组HR、MAP差异无统计学意义（P>0.05）；T₀、T₁、T₂、T₃、T₄、T₅时两组RR、SpO₂、rSO₂差异无统计学意义（P>0.05）；丙泊酚组药物平均使用量多于依托咪酯组，追加药物次数少于依托咪酯组（P<0.05）；两组麻醉起效时间差异无统计学意义（P>0.05）；依托咪酯组呛咳反应发生率高于丙泊酚组（P<0.05）；两组呼吸抑制发生率、躁动发生率差、纤维支气管镜操作医生对镇静效果满意度差异无统计学意义（P>0.05）。结论 丙泊酚与依托咪酯乳剂在ICU机械通气颅脑损伤合并肺部感染患者行纤维支气管镜治疗中均具有良好镇静效果，其中依托咪酯药物平均使用量较少，对HR、MAP、BIS影响较小，但追加药物频次、呛咳反应发生率较高。

Evaluation of sedative effect and safety of propofol and etomidate emulsion in patients with craniocerebral injury combined with pulmonary infection treated by fiberoptic bronchoscopy

Objective To observe the sedative effect and safety of propofol and etomidate emulsion in patients with craniocerebral brain injury combined with pulmonary infection treated by fiberoptic bronchoscopy.Methods A total of 84 patients with craniocerebral injury combined with pulmonary infection and mechanical ventilation in ICU from January 2019 to August 2021 in the Second Hospital of Hebei Medical University were selected as the research objects.They were divided into propofol group and etomidate group according to different medication schemes, with 42 patients in each group.Patients in both groups were treated with fiberoptic bronchoscope.Patients in propofol group were treated with 1-2 mg·kg^-1 of Propofol Emulsion Injection, and was given a slow artificial static push for 3-5 min.Patients in etomidate group were given 0.2-0.4 mg·kg^-1 of Etomidate Medium/Long Chain Fat Emulsion Injection, and the injection was given slowly.During the operation, if the patient''s restlessness is obvious or cough severely affects the entry, or the trachea wall bleeds, 30 mg of propofol or 6 mg of etomidate were added.The differences of bispectral index(BIS), heart rate(HR), respiratory rate(RR), mean arterial pressure(MAP), blood oxygen saturation(SpO₂), cerebral oxygen saturation(rSO₂) at five minutes before administration(T₀), after administration-immediately after entering the mirror(T₁), three minutes after entering the mirror(T₂), 10 min after entering the mirror(T₃), immediately after removing the mirror(T₄), and five minutes after operation(T₅), respectively.The dosage of drugs, times of additional drugs, onset time of anesthesia, occurrence of adverse reactions and satisfaction of fiberoptic bronchoscope operators on sedation effect were compared between the two groups.Results The BIS of the two groups at T₁, T₄ and T₅ were lower than that of the group at T₀, and BIS of the two groups at T₂ and T₃ higher than that of the group at T₀(P<0.05).There was no significant difference in BIS between the two groups at T₀, T₂, T₄ and T₅(P> 0.05).At T₁ and T₃, BIS in propofol group was lower than that in etomidate group(P<0.05).HR and MAP in propofol group were lower than those in etomidate group at T₁, T₂, T₃ and T₄(P<0.05).There was no significant difference in HR and MAP between the two groups at T₀ and T₅(P> 0.05).There was no significant difference in RR, SpO₂ and rSO₂ between the two groups at T₀, T₁, T₂, T₃, T₄ and T₅(P> 0.05).The drug use amount and the number of additional drugs in etomidate group were higher than those in propofol group(P<0.05).There was no significant difference in onset time of anesthesia between the two groups(P> 0.05).The incidence of cough reaction in etomidate group was higher than that in propofol group(P<0.05).There was no significant difference between the two groups in the incidence of respiratory depression, restlessness, and the satisfaction of fiberoptic bronchoscope operators with sedation effect(P> 0.05).Conclusion Propofol and etomidate emulsion have good sedative effect in patients with mechanical ventilation craniocerebral injury combined with pulmonary infection in ICU undergoing fiberoptic bronchoscopy.The average use of etomidate is less, which has little impact on HR, MAP and BIS, but the frequency of additional drugs and the incidence of cough reaction are higher.