单独持续输注瑞芬太尼用于老年高血压患者纤维支气管镜检术清醒镇静的临床探讨

目的 观察单独输注瑞芬太尼用于老年高血压患者支气管镜检术清醒镇静的临床效果和安全性.方法 选取行支气管镜检查的80例老年高血压作为研究对象,分为A、B、C、D共4组各20例,分别设定瑞芬太尼以0.05、0.1、0.2μ g/（kg·min）持续输注,D组采用异丙酚4mg/L静脉注射,瑞芬太尼0.1μg/（kg·min）持续输注,同时用2％利多卡因作鼻腔至气管的表面麻醉,瑞芬太尼总量至1μg/kg后行支气管镜气管插管.记录T0（麻醉前静息时）、T1（入镜前）、T2（进入声门即刻）、T3（插入气管导管即刻）以及T4（退镜完毕时）各时间点的平均动脉压（MAP）、心率（HR）、脑电双频指数（BIS）,以及不良反应发生情况及操作满意度和病人满意度.结果 D组患者在支气管镜检查时,T1-T4各时间点MAP、HR和BIS平均值均较麻醉前基础值均明显下降（P＜0.05）,呼吸抑制几率明显较A、B组高（P＜0.05）,但操作满意度和病人满意度较高,A组发生呛咳反应剧烈和体动程度较重,操作满意度和病人满意度均低,C组在T1、T2时间点较T0时MAP下降明显（P＜0.05）,且呼吸抑制发生几率较高,B组患者血流动力学指标和BIS均无明显变化（P＞0.05）,且呛咳、躁动和支气管痉挛较A组发生几率较低,操作和病人满意度较高（P＜0.05）,与D组相比,呼吸抑制发生几率小（P＜0.05）.结论 单纯瑞芬太尼0.1 g/（kg·min）持续输注至1μg/kg,可为老年性高血压患者行支气管镜清醒插管提供良好麻醉条件,且安全性高.

Feasibility study of continuous remifentanil infusion alone for conscious sedation during fiberoptic bronchoscope examination

[Abstract] Objective To study the clinical efficacy and safety of remifentanil infusion alone for conscious sedation during fiberoptic bronchoscope examination. Methods 80 cases of senile hypertension were divided into A, B, C, D four groups （n= 20） ; and given remifentanil with infused continuously at a rate of 0.05, 0. 1, 0.2μg/（kg ·min） espectively, the propofol intravenous 4mg/L, remifentanil 0.1μg/（kg · min） infused continuously in D group. At the same time with 2 % lidocaie anesthesia nasal and tracheal surface, remifentanil total to 1μg/kg hronehoseopy tracheal intubation. Mean arterial pressure （MAP）, heart rate（HR）, bispectral index （BIS）,and the adverse reactions, operation satisfaction and patient satisfaction survey were recorded at TO （before anesthesia resting）, T1 （before FOB was inserted into nasal cavi- ty） ,T2 （enter the glottis） ,T3 （insert the endotracheal tube immediately） and T4 （backmirror finished） five times. Results Compared with those before anesthesia, MAP, HR and BIS mean values were decreased in D group in each time of T1-T4 point of significantly （P〈0.05） ,and respiratory inhibition rate is lower compared with A, B group （P〈0.05）, but the operation satisfaction and patient satisfaction is higher than A group（P〈0.05）. The rate of cough drastic and dysphoriain A group were higher than D group（P〈0.05）. In group C, MAP decreased significantly during T1 and T2 time point, compared with TO （P〈0.05）, and respiratory depression incidence is higher. The hemodynamies and BIS had no signifi- cant change in B group （P〉0.05）, and the rate of cough,agitation and bronchial spasm are lower, odds, and patient sat- isfaction is higher than A group（P~0.05）. Compared with the D group, the incidence of respiratory inhibition was low （P〈0.05）. Conclusion The continuous remifentanil infusion as 0.1μg/（kg·minn） alone provides a good intubation con- dition and safety during fiberoptic bronchoscope examination among aged patients with hypertension.