右美托咪定和瑞芬太尼持续静脉输注在老年高血压患者纤支镜检查中的应用

目的 比较右美托咪定和瑞芬太尼持续静脉输注在老年高血压患者纤支镜检查中的应用效果及对血流动力学的影响.方法 40例临床确诊为原发性高血压病的老年患者,随机分为右美托咪定组（D组,n=21）和瑞芬太尼组（R组,n=19）.气管内表面麻醉后,D组给予右美托咪定1.0μg/kg 10min继以0.5μg/（kg·min）持续静脉输注;R组给予瑞芬太尼1.0μg/kg 后以0.1μg/（kg·min）持续静脉输注.记录麻醉前（T0）、麻醉后纤支镜进入前（T1）、进镜至咽部（T2）、声门部（T3）、气管内（T4）及第10 min（T5）时的血压（BP）、心率（HR）、脉搏血氧饱和度（SpO2）以及Ramsay评分,观察镜检期间有无呛咳、气道痉挛或体动;记录停药至出室的时间,麻醉满意度及麻醉再接受度.结果 与T0时比较,T2～T4时两组BP、HR均升高或增快,且R组高于/快于D组（P＜0.05）;D组患者镜检期间更加安静配合,呛咳、体动发生率低于R组;两组患者均能在术毕5～10min清醒;D组麻醉满意度及患者再接受度均显著高于R组（P＜0.05）.结论 气管表面麻醉后持续输注右美托咪定较瑞芬太尼能更好地为老年高血压患者提供纤支镜检查条件,血流动力学变化更小,不良反应少.

Effects of dexmedetomidine or remifentanil on sedation and hemodynamic in patients with hypertension during fiber optic bronchoscope check-up

Objective To observe the effects of dexmedetomidine or remifentanil on sedation and hemodynamic in patients with hypertension during fiber optic bronchoscope check-up. Methods Forty patients with hypertension scheduled to undergo fiber optic bronchoscope check-up were divided into dexmedetomidine group （group D） and remifentanil group （group R）. In group D, dexmedetomidine was administered intravenously at 0. 5 μg/ （kg· h） after a bolus infusion at 1. 0μLg/kg for 10 min. In group R, Remifentanil was administered intravenously at 0. 1μg/（ kg · h） after a bolus infusion at 1. 0μLg/kg. All the patients received topical anaesthesia with lidocaine 2 % before anesthesia induction. BP, HR, SpO2 and ramsay scores were recorded at the following time points： before anaesthesia（ baseline, TO） and immediately after anaesthesia induction （ T1 ） , when FOB at the level of pharynx （ T2） , vocal cords （ T3） , trachea（ T4） and in 10 min of the FOB（ T5）. Laryngospasm and cough were observed at every time point. Intraoperative satisfication （evaluated by endoscopy doctor） and post-operative complication （evaluated by patient） were also analyzed. Results Compared with TO, there were significant increases in HR and BP at T2 - T4 （P 〈 0. 05） ; HR and BP were significantly lower in group D than that in group R at T2 - T4 （P 〈 0. 05）. Incidence of cough and body movements were obviously lower in group D than in group R. Intra-operative satisfaction and post-operative complication were both higher in group D than in group R. Conclusion Combined with topical anesthesia, dexmedetomidine infusion resulted in more stable hemodynamic and smooth anesthesia than remifentanil in patients with hypertension during fiber optic bronchoscope check-up.