丙泊酚与瑞芬太尼靶控输注联合高频通气在纤维支气管镜术中的应用

The efficacy of the target-controlled infusion of propofol and remifentanil with high frequency jet ventilation in fiber-optic bronchoscopy

目的本研究探讨丙泊酚复合瑞芬太尼靶控输注联合高频通气在诊断性纤维支气管镜(纤支镜)术中应用的可行性。方法 88例拟行诊断性纤支镜术患者随机分为常规适度镇静组(PF组,n=42)和高频通气靶控输注组(PRH组,n=46),PF组静注芬太尼50μg及丙泊酚1.5mg/kg,术中根据患者意识、体动和咳嗽情况每次静注丙泊酚20mg,PRH组静脉血浆靶控输注丙泊酚和瑞芬太尼,初始血浆靶浓度分别为4μg/ml和4ng/ml,并行高频通气,术中根据情况调整瑞芬太尼靶浓度。观察记录患者的SpO2、MAP、HR、咳嗽评分、动脉血PCO2、纤支镜检查时间、意识恢复时间、低氧血症发生率、患者满意度评分等指标。结果 PF组平均SpO2、最低SpO2均明显低于PRH组,低氧血症发生率明显高于PRH组(P<0.01)。于术前即刻、到达隆突时PF组MAP显著高于,HR明显快于PRH组(P<0.01)。PF组咳嗽评分明显高于,患者满意度评分明显低于PRH组(P<0.05或P<0.01);PF组纤支镜检查时间明显长于PRH组(P<0.05)。结论丙泊酚和瑞芬太尼靶控输注联合高频通气应用于诊断性纤支镜术安全有效,与常规适度镇静相比,可减少术中低氧血症的发生率,降低咳嗽评分,维持血流动力学平稳。

Objective To evaluate the efficacy and safety of the target-controlled infusion （TCD of propofol and remifentanil for deep sedation with high frequency jet ventilation （HFJV） in diagnostic fiber-optic bronchoscopy. Methods A total of eighty-eight consecutive patients scheduled for flexible bronchoscopy were randomly assigned to receive propofol plus fentanyl （group PF） or TCI-delivered propofol plus remifentanil with HFJV （group PRH）. Patients in the group PF received 50 μg of fentanyl and 1.5 mg/kg of propofol, and additional 20 mg of propofol according intraoperative reactivity; patients in the group PRH received an initial doses of propofol and remifentanil 4 μg/ml and 4ng/ml, respectively, and performing high jet ventilation. Following variables were recorded： SpO2, MAP, HR, cough, PaCO2, examining time, time of recovery from anesthesia, and satisfaction. Results The average and minimum SpO2 in the group PF were lower than in the group PRH, and the group PF showed a higher incidence of hypoxemia （P〈0. 01）. MAP and HR values in the group PF were higher immediately before bronchoseopy and at the time reaching the carina （P〈0.01）. The cough score in the group PF were markedly lower in the group PRH, and patient satisfaction score were higher than the group PF, examinine time of bronchoscopy in the group PF was significantly longer than that in the group PRH（P〈0. 05 or P〈0.01）. Conclusion TCI- delivered propofol and remifentanil for deep sedation with HFJV is a safe regimen in diagnostic bronchoscopy, with the advantage of providing a better brochoscopy condition due to effectively suppressing the airway reflex and sympathetic response.