60例小剂量咪唑安定、丙泊酚复合芬太尼静脉麻醉在纤维支气管镜检查中的应用分析

Effects of low dose of midazolam and propofol combined with fentanil on anesthesia and respiration and circulation during bronchofiberscopy in 60 cases

目的观察小剂量咪唑安定、丙泊酚复合芬太尼静脉麻醉在纤维支气管镜(简称纤支镜)检查中的麻醉效果及对呼吸、循环的影响。方法将60例ASAⅠ或Ⅱ级要求进行无痛纤支镜检查的患者随机分为3组,即丙泊酚组(A组),丙泊酚复合芬太尼组(B组),小剂量咪唑安定、丙泊酚复合芬太尼组(C组)。观察各组麻醉前、麻醉后2、5min及苏醒时的SBP、DBP、PR、RR、SaO2变化,同时纪录各组纤支镜检查时间、苏醒时间、麻醉药物用量,检查中体动、呛咳及检查后头晕、嗜睡、乏力、恶心、呕吐等不良反应情况。结果3组患者均顺利完成了纤支镜检查,术后无记忆,表示乐于接受无痛纤支镜检查,均未出现严重的低血压、心动过缓以及严重的低氧血症等。术中3组患者呛咳、体动等不良反应及术后3组患者头晕、嗜睡、乏力、恶心、呕吐等不良反应差异均无统计学意义。麻醉后25、min A组患者SBP、DBP显著下降(P<0.05或P<0.01),B、C组患者SBP、DBP亦下降(P<0.05);麻醉后2、5min A、B组患者RR显著下降(P<0.05或P<0.01)。C组患者苏醒时间显著缩短(P<0.05或P<0.01),丙泊酚用量显著减少(P<0.01)。结论小剂量咪唑安定、丙泊酚复合芬太尼静脉缓注可为纤支镜检查提供安全可靠快捷的麻醉。

Objective To investigate the effects of low dose of midazolam and propofol combined with fentanil on anesthesia and respiration and circulation during bronchofiberscopy. Methods Sixty patients classified as ASA physical status Ⅰ or Ⅱ undergoing bronchofiberscopy were divided into three groups：propofol for anesthesia during bronchofiberscopy （group A, 20 cases） ;propofol and fentanii （group B,20 cases） and low dose of midazotam and propofol combined with fentanil （group C, 20 cases）. SBP, DBP, PR,RR and SaO2 were monitored and recorded before anesthesia,2 min and 5 min after anesthesia and at the time of palinesthesia. The time for bronchofiberscopy,the time from anesthesia till palinesthesia, the dosage of anesthetics, the adverse reactions during bronchofiberscopy such as body motion and bucking and the adverse reaction after bronchofiberscopy such as dizziness,drowsiness, anergy,nausea and vomiting were also recorded. Results All the patients in three groups received bronchofiberscopy successfully without memory about the procedure after operation. There was no severe hypotension, bradycardia or hypoxemia in each group. There was no significant difference in adverse reaction before or after operation among the three groups. SBP and DBP in group A descended significantly after anesthesia for 2 min and 5 min（P〈0.05 or P〈0.01 ）. SBP and DBP in group B and group C descended significantly after anesthesia for 2 min and 5 min （P〈0.05）and RR in three groups descended significantly after anesthesia for 2 min and 5 min（P〈0.05）. The time for palinesthesia was dramatically shorter than that of group A （P〈0.05） and group B （P〈0. 01）. The dosage of propofol in group C was lower compared with that in group A and group B （P〈0.01）. Conclusion Low dose of midazolam and propofol combined with fentanil by slow intravenous injection could provide safe, reliable and rapid anesthesia for bronchofiberscopy.