普鲁泊福复合芬太尼静脉麻醉用于纤维支气管镜检查的效果评价

目的 评价普鲁泊福复合芬太尼静脉麻醉用于纤维支气管镜(纤支镜)检查的效果.方法 择期行纤支镜检查患者40例,ASA分级Ⅰ～Ⅱ级,按随机数字表法分为对照组和普鲁泊福复合芬太尼静脉麻醉组(静脉麻醉组),每组各20例.两组术前均使用2%利多卡因行鼻腔和咽喉部表面麻醉.对照组静脉注射0.9%氯化钠10 ml后检查,术中行鼻导管给氧;静脉麻醉组静脉注射普鲁泊福1.5 mg/kg、芬太尼1 μg/kg麻醉诱导后开始检查,术中行内镜面罩给氧.记录两组患者麻醉前(T_1)、静脉注药后1 min(T_2)、纤支镜入声门即刻(T_3)、纤支镜人声门后3 min(T_4)、检查结束后患者完全清醒时(T_5)的平均动脉压(MAP)、心率和脉搏血氧饱和度(SpO_2).记录检查时间、苏醒时间、术后疼痛视觉模拟评分(VAS)、重复检查依从性评分和术中知晓情况.结果40例患者均顺利完成纤支镜检查.静脉麻醉组患者术后VAS和重复检查依从性评分(1 ±2)、(2±3)分]均低于对照组(7±1)、(7±3)分](P<0.05).对照组T_3、T_4、T_5MAP和心率较T_1升高(P<0.05);静脉麻醉组T_2MAP和心率较T_1降低(P<0.05),T_3心率较T_1升高(P<0.05).与对照组比较,静脉麻醉组T_3、T_4、T_5MAP和心率降低(P<0.05),T_2心率降低(P<0.05).静脉麻醉组患者均无术中知晓发生.结论 普鲁泊福复合芬太尼静脉麻醉可安全有效地用于纤支镜检查.

Evaluation of the effects of intravenous anesthesia with propofol and fentanyl on flexible fiberoptic bronchoscopy

Objective To evaluate the effects of intravenous anesthesia with propofol and fentanyl on flexible fiberoptic bronchoscopy (FFB).Methods Forty ASA Ⅰ - Ⅱ patients undergoing elective FFB were randomly divided into two groups (20 cases in each group): control group and intravenous anesthesia group.All patients received airway local topical anesthesia with 2% lidocaine before the procedure.The patients in intravenous anesthesia group received propofol 1.5 mg/kg and fentanyl 1 μ g/kg intravenous injection for induction while in control group normal saline was given instead.Supplemental oxygen was administered by the endoscopy face mask.The mean arterial pressure (MAP),heart rate (HR)and pulse oxygen saturation (SpO_2) were continuously monitored and recorded before induction of anesthesia (T_1, baseline), 1 min after intravenous injection (T_2) ,immediately and 3 min after intubation (T_3,T_4),after FFB (T_5).The persistence time of the procedure was noted.When the patients responded to commands exactly, the recovery time was recorded.All patients were interviewed for the global tolerance to the procedure, the acceptance of another fiberoptic bronchoscopy and the degree of amnesia.Results All of the 40 patients finished FFB successfully.VAS postoperation and dependence scores were lower in intravenous anesthesia group than those in contrel group(1±2),(2±3) scores and (7±1),(7±3) scores](P< 0.05).MAP and HR at T_3, T_4 and T_5 were significantly increased compared with baseline values at T_1 in control group (P <0.05).MAP and HR at T_2 was lower than those at T_1,HR at T_3 was higher than that at T_1 in intravenous anesthesia group (P < 0.05 ).Compared with control group, MAP and HR at T_3, T_4 and Ts were lower, HB at T_2 was lower in intravenous anesthesia group (P < 0.05).There was no awareness during the FFB in intravenous anesthesia group.Conclusion Intravenous anesthesia with propofol and fentanyl is safe and effective for FFB.