咪唑安定和芬太尼在老年患者纤维支气管镜检查中的应用

Anesthesia with Midazolam and Fentanyl in Fibrobronchoscopy Examination for Elderly Patient

目的观察咪唑安定和芬太尼在老年患者纤维支气管镜检查中的应用效果及安全性评价。方法将210例接受纤维支镜检查的老年患者随机分成试验组(A组)和对照组(B组),同时选择同期106例青年患者作为对照(C组),A、C两组在局部麻醉的基础上加用咪唑安定和芬太尼进行麻醉,B组单纯应用局部麻醉,分别观察3组各时点的平均动脉压、心率、呼吸频率及脉氧饱和度。对A、C两组患者按Ramsay法进行镇静分级评估,记录A、C两组的麻醉诱导时间和麻醉时间。调查3组患者对检查过程的遗忘程度、不良反应以及再次检查的接受程度。结果A组麻醉时间高于C组(P<0.01)。A、C两组遗忘比率分别为97.2%(103/106)和95.3%(101/106),镇静分级评估A组以3级为主占68.9%(73/106),C组以2级为主占66.0%(70/106),而B组镇静程度全部为0级,无遗忘。A、C两组在检查过程中平均动脉压稍下降,但平稳,而B组显著升高,波动大。B组心率入声门时比A、C两组显著加快(P<0.01)。A、C两组在检查过程中的不良发应、中断检查及再次检查接受程度与B组比较差异有统计学意义(P<0.01)。结论老年患者在纤维支气管镜检查联合应用咪唑安定和芬太尼麻醉安全有效。

Objective To study the efficacy and safety of intravenous anesthesia with midazolam and fentanyl for fibrobronchoscopy for elderly patient. Methods 210 elderly patients of using fibrobronchoscopy were randomly divided into trial group （group A） and normal group （group B）, and 106 young patients were selected to make up group C. Those in group A and C received local anesthesia combined with in intravenous anesthesia with midazolam and fentanyl, whereas those in group B received only local anesthesia. The mean arterial pressure （MAP）, heart rate （HR）, respiratory rate （RR） and pulse oxygen saturation （SPO2） were measured. The induction time of anesthesia and time of recovery from anesthesia were recorded in group A and C. All the patients were reviewed for oblivion, adverse reaction and teh willingness for re-examination. Results The time of recovery from anesthesia in group A was longer than that in group C （P〈0.01）. The ratio of oblivion in group A was 97.2%（103/106）, which in group C was 95.3%（101/106）, conscious-sedation class appraisal of group A in class 3 was 68.9% （73/106）, group C in class 2 was 66.0% （70/106）, whereas group B were in class 0. The MAP in group A and C declined but still stable, while that in group B was obviously elevated. The HR in group B was significant faster than in group A and C （P〈0.01）. The adverse reaction and willingness of discontinuance or re-examination showed significant difference between group A, C and group B （P〈0.01）. Conclusion Intravenous anesthesia with midazolam and fentanyl for fibrobronchoscopy for elderly patient is safe and effective.