丙泊酚靶控输注和间断推注在改良喉罩全麻无痛纤支镜检查中的应用

目的:比较丙泊酚靶控输注和间断推注在改良喉罩全麻纤支镜检查中的应用效果,探讨合理用药方式。方法:ASAⅠ～Ⅱ级拟行纤支镜检查病人40例,随机分为间断推注组(A组)和靶控输注组(B组),每组20例。两组病人麻醉诱导相同,置入改良喉罩后行手动辅助通气。纤支镜检查期间A组病人发生4级体动时推注丙泊酚0.5 mg/kg。B组喉罩置入后设初始血浆靶浓度3μg/ml,发生4级体动时靶浓度增加0.5μg/ml,血压<基础值20%则降低靶浓度0.5μg/ml。记录麻醉前、睫毛反射消失、置入喉罩、纤支镜过声门、入声门后5 min和检查结束各时点的MAP、HR、SpO2,同时记录诱导、唤醒及定向力恢复时间,观察4级体动发生次数、丙泊酚追加次数、呛咳、呃逆以及低氧血症等发生情况。结果:A组检查中各时点MAP和HR的波动较B组明显(P<0.05);B组的唤醒时间、定向力恢复时间较A组短,而体动、呛咳、呃逆发生率以及追加丙泊酚的次数低于A组,组间差异均有统计学意义(P<0.05)。结论:改良喉罩全麻纤支镜检查中,靶控输注丙泊酚具有血流动力学较稳定、苏醒快速、不良反应少的优点,是一种安全可行的给药方法。

Application of improved laryngeal mask combined with target-controlled infusion and interval infusion of propofol to analgesia in fiberoptic bronchoscopy

Objective:To compare the efficacy of the profile by applying improved laryngeal mask combined with either infusion of propofol at discrete intervals or target-controlled infusion to analgesia in patients undergoing fiberoptic bronchoscopy(FOB) for rational anesthetic dosage.Methods:Forty patients(ASA Ⅰ-Ⅱ) undergoing bronchofibroscopy were randomized into equal group A(infusion of propofol at discrete intervals) and group B(target-controlled infusion of propofol)with similar anesthetic induction.Manually assisted ventilation was carried out in the two groups at placement of the improved laryngeal mask.Patients in group A were managed with infusion of propofol in dose of 0.5 mg/kg during the procedure at body response by stage Ⅳ.In group B,the target plasma concentration of propofol was initially set at 3 μg/ml after successful placement of the laryngeal mask and increased by 0.5 μg /ml at body response by stage Ⅳ,whereas decreased by 0.5 μg /ml upon 20% fall of the basic value of blood pressure.Mean arterial pressure(MAP),heart rate(HR) and SpO2 were maintained at the time points of prior to anesthesia,loss of eyelash reflex,placement of laryngeal mask,bronchofibroscope through the vocal cords,five minutes after bronchofibroscope passage down the vocal cords and completion of check-up.Records were also kept concerning the induction time,awakening from anesthesia,duration of orientation force recovery,frequencies of body response at stage IV,extra dosage of propofol and occurrences of bucking,hiccupping and hypoxemia.Results:The fluctuation of MAP and HR during the procedure was more significant in group A compared to group B(P<0.05),whereas the group B had shorter time for awakening and recovery of the orientation force,lower incidences of body response,bucking and hiccoughing and less dose requirement of additional propofol.The two groups were statistically different(P<0.05).Conclusion:Application of improved laryngeal mask with target-controlled infusion of propofol to fiberoptic brohchoscopy may ensure stable hemodynamics and early awakening from anesthesia,yet produce less adverse effects,suggesting that this profile is a safe recommendation in clinic.