摘要
目的探讨右美托咪定(DEX)复合小剂量丙泊酚和舒芬太尼用于无痛支气管镜检查的镇静效果。方法抽取2018年7月至2020年7月于太原钢铁(集团)有限公司总医院收治的112例无痛支气管镜检查患者,按随机数字表法分为丙泊酚组和复合组,每组56例。复合组选择0.8μg/kg DEX 15 min泵注,在泵注5 min时给予舒芬太尼0.1μg/kg,后给予丙泊酚0.8~2.0 mg/kg麻醉诱导和维持;丙泊酚组泵注与复合组相同剂量的生理氯化钠溶液15 min,在泵注5 min时给予舒芬太尼0.1μg/kg,后给予丙泊酚0.8~2.0 mg/kg麻醉诱导和维持。比较两组不同时刻包括入室时(T0)、麻醉诱导后(T1)、进入声门时(T2)、到达隆突时(T3)、检查完成时(T4)的血流动力学指标包括平均动脉压(MAP)、心率(HR)和脉搏血氧饱和度(SpO2),镇静效果包括警觉/镇静(OAA/S)评分,观察两组检查时间、苏醒时间及丙泊酚用量和不良反应。结果两组T0~T4时刻关于MAP、HR的时间交互、组间交互以及时间与组间交互效应比较,以及两组T0~T4时刻SpO2时间交互比较,差异均有统计学意义(P均<0.05),其中两组在T1~T4时刻关于MAP、HR逐渐降低,其中复合组T1~T4时刻MAP高于丙泊酚组(P<0.05),复合组T1~T4时刻的HR低于丙泊酚组(P<0.05);两组T0~T4时刻关于OAA/S评分的时间交互、组间交互以及时间与组间交互效应比较,差异均有统计学意义(P均<0.05),其中复合组T4时刻的OAA/S评分高于丙泊酚组(P<0.05);复合组的苏醒时间短于丙泊酚组(P<0.05),丙泊酚用量少于丙泊酚组(P<0.05),两组镜检时间比较差异未见统计学意义(P>0.05);复合组不良反应总发生率为10.71%,低于丙泊酚组的41.07%(P<0.05)。结论DEX复合小剂量丙泊酚和舒芬太尼用于无痛支气管镜检查能保证患者血流动力学稳定,提高镇静效果,利于患者唤醒且能减少丙泊酚使用剂量,减少不良反应。
Objective To investigate the sedative effect of dexmedetomidine(DEX)combined with low-dose propofol and sufentanil on painless bronchoscopy.Methods A total of 112 patients with painless bronchoscopy treated in Taiyuan Iron Group General Hospital from July 2018 to July 2020 were selected,and were divided into propofol group and combined group by random number table method,with 56 cases in each group.The combined group was given pump injection of 0.8μg/kg of DEX for 15 min,applied 0.1μg/kg of sufentanil at 5 min of pump injection and then given 0.8-2.0 mg/kg of propofol for anesthesia induction and maintenance,and the propofol group was pumped with physiological sodium chloride solution at the same dose as the combined group for 15 min,adopted 0.1μg/kg of sufentanil at 5 min of pumping and then added 0.8-2.0 mg/kg of propofol for anesthesia induction and maintenance.The hemodynamic indicators including mean arterial pressure(MAP),heart rate(HR),pulse blood oxygen saturation(SpO2)and sedative effect including Observers Assessment of Alertness/Sedation Scale(OAA/S)of the two groups were compared at different time points including at entering the room(T0),after induction of anesthesia(T1),at entering the glottis(T2),at reaching the carina(T3)and at the completion of examination(T4).The examination time,awakening time,propofol dosage and adverse reactions were observed in the two groups.Results There were statistically significant differences in the time-point interaction,between-group interaction and interaction effect of time-point and between-group of MAP and HR at T0-T4 and time-point interaction of SpO2 at T0-T4(all P<0.05),and the MAP and HR in the two groups were gradually decreased at T1-T4,and the MAP of the combined group at T1-T4 was significantly higher than that of the propofol group(P<0.05),and the HR at T1-T4 of the combined group was significantly lower than that of the propofol group(P<0.05).Comparison of time-point interaction,between-group interaction and interaction effect of time-point and between-groups of OAA/S score at T0-T4 found statistically significant differences(all P<0.05).The OAA/S score of combined group at T4 was significantly higher than that of propofol group(P<0.05).The awakening time of the combined group was significantly shorter than that of the propofol group(P<0.05),and the dosage of propofol was significantly less than that of the propofol group(P<0.05),but there was no statistical significance in the bronchoscopy examination time between the two groups(P>0.05).The total incidence rate of adverse reactions was 10.71%in the combined group,which was significantly lower than 41.07%in the propofol group(P<0.05).Conclusions The application of DEX combined with low-dose propofol and sufentanil in painless bronchoscopy can ensure the hemodynamic stability,improve the sedative effect,facilitate the awakening of patients,lower the dosage of propofol,and reduce the adverse reactions.
作者
王荣
Wang Rong(Department of Anesthesiology,Taiyuan Iron Group General Hospital,Taiyuan 030008,China)
出处
《中国实用医刊》
2022年第4期56-60,共5页
Chinese Journal of Practical Medicine
作者简介
通信作者:王荣,Email:meixu66@126.com。
