纤维支气管镜检查术患者不同效应室靶浓度异丙酚复合瑞芬太尼麻醉效果的比较

目的 比较纤维支气管镜检查术患者不同效应室靶浓度(Ce)异丙酚复合瑞芬太尼的麻醉效果.方法 拟行纤维支气管镜检查术患者180例,年龄18～60岁,随机分为6组(n=30):P5.0 R2.5 组、P5.5 R2.5组、P6.0 R2.5组、P5.0 R3.0组、P5.5 R3.0组和P6.0 R3.0组,检查前TCI异丙酚和瑞芬太尼,异丙酚Ce分别设为5.0、5.5和6.0 μg/ml,瑞芬太尼ce分别设为2.5和3.0.g/ml,持续监测MAP、HR及SpO2,效应室浓度均达靶浓度时开始检查,连续性阵咳或支气管痉挛时采用2%利多卡因经纤维支气管镜滴至气管作表面麻醉,MAP下降>基础值30%和/或HR<55次/min时静脉注射麻黄碱,MAP升高>基础值30%和/或HR>120次/min时静脉注射瑞芬太尼,检查结束时停止TCI.记录异丙酚与瑞芬太尼的用量、麻醉诱导时间、检查时间及苏醒时间.记录表面麻醉、静脉注射麻黄碱和/或瑞芬太尼患者的总例数,评估麻醉效果并记录术者满意度.结果 P6.0 R2.5组和P6.0 R3.0组的麻醉诱导时间和苏醒时间较其余组延长,P5.5 R3.0组和P6.0 R3.0组的麻醉效果较P5.0R2.5组、P5.5 R2.5组及P5.0 R3.0组好,P5.5 R3.0组术者满意度较其余组升高,P5.5 R3.0组表面麻醉、麻黄碱和/或瑞芬太尼的使用率较其余组降低(P<0.05).结论 纤维支气管镜检查术患者TCI异丙酚(Ce 5.5μg/ml)复合瑞芬太尼(Ce 3.0 ng/ml)时麻醉效果较好.

Comparison of efficacy of anesthesia with TCI of propofol and remifentanil for fiberoptic bronchoscopy

Objective To determine the most appropriate combination of target effect-site concentrations (Ce) of propofol and remifentanil administered by TCI for fiberoptic bmnchoscopy in terms of depth of anesthesia and safety.Methods One hundred and eighty ASA Ⅰ or Ⅱ patients of both sexes aged 18-60 yr with body mass index ranging from 20-25 kg/m2 undergoing elective fiberoptic bronchoscopy under general anesthesia were randomized into 6 groups based on Ce of propofol (5.0,5.5,6.0 μg/ml) and remifentanil(2.5,3.0 ng/ml)(n=30 each):P5.0 R2.5,P5.5 R2.5,P6.0 R2.5,P530 R3.0,P5.5 R3.0 and P6.0 R3.0.Anesthesia was induced and maintained with TCI of propofol and remifentanil.MAP,HR,and SpO2 were continuously monitored.The examination was started when the target Ce was reached.When continuous coughing or bronchospasm occurred,2% lidocaine was given for topical anesthesia.When MAP decreased by more than 30% of the baseline value and/ or HR<55 boats per min,ephedrine was injected iv.When MAP increased by more than 30% of the baseline value and/or HR>120 beats per min,remifentanil was injected iv.TCI was stopped when the examination was over.The amount of propofol and remifentanil consumed,induction time,emergence time,duration of bronchoscopy and the number of the patients in whom ephedrine and intermittent iv boluses of remifentanil were given were recorded and compared among the 6 groups.The efficacy ofanesthesia was evaluated and the doctors' satisfaction recorded.Results The induction time and emergence time were significantly longer in P6.0 R3.0 and P6.0 R2.5 groups than in the other 4 groups ( P < 0.05). The efficacy of anesthesia was better in group P5.5 R3.0 and P6.0 R3.0 than in group P5.0 P2.5, P5.5 R2.5 and P5.0 R3.0 ( P < 0.05). Anesthesia was more satisfactory as evaluated by the doctor in group P5.5 R3.0.The number of patients who received iv bolus of remifentanil and ephedrine during bronchoscopy was smallest in group P5.5 R3.0 ( P < 0.05 ). Conclusion TCI of propofol at Ce of 5.5 μg/ml combined with remifentanil TCI at Ce of 3.0 ng/ml provides satisfactory anesthesia for flberoptic bronchoscopy.