肺功能减退老年患者异丙酚联合舒芬太尼静脉麻醉支气管镜检查安全性评估

Evaluation of the Safety of Bronchoscopy under Intravenous Anesthesia with Propofol Combined with Sulfentanyl in Elderly Patients with Pulmonary Dysfunction

目的观察肺功能减退老年患者异丙酚联合舒芬太尼静脉麻醉支气管镜检查(无痛镜检)的安全性。方法选取首都医科大学附属北京朝阳医院76例行无痛支气管镜检查的老年患者,依据肺功能情况分为2组,A组42例为肺功能正常及轻度减损组,B组34例为肺功能明显减退组。观察麻醉前、麻醉后镜检前、麻醉后镜检中、麻醉清醒后、操作24 h后血压、心率(heart rate,HR)、呼吸频率(respiration rate,RR)、血氧饱和度(oxygen saturation by pulse oxymetry,SpO2)的变化,并记录麻醉后不良反应及苏醒时间;镜检中2组均予以鼻导管吸氧。结果麻醉后2组患者收缩压(systolic pressure,SP)、舒张压(diastolic pressure,DP)、HR均下降,与用药前相比差异有统计学意义(P<0.05)。B组麻醉后操作前SpO2、RR明显下降,与A组比较差异无统计学意义。2组麻醉后镜检中、麻醉清醒后SpO2差异无统计学意义。操作24 h后2组HR、SP、DP、RR及SpO2与镜检前差异无统计学意义。术后苏醒时间及不良反应2组差异无统计学意义。结论密切监护下肺功能减退老年患者无痛镜检是安全的,但应注意呼吸抑制的发生,并及早加强呼吸管理。

Objective To evaluate the safety of bronchoscopy under intravenous anesthesia with propofol combined with sulfentanyl（painless bronchoscopy） in elderly patients with pulmonary dysfunction.Methods Seventy-six elderly patients who undergoing painless bronchoscopy were enrolled and divided into two groups according to pulmonary function.Group A had 42 cases with normal or slight dysfunction and group B had 34 cases with significant hypofunction.Their blood pressure,heart rate（HR）,respiration rate（RR） and oxygen saturation by pulse oxymetry（SpO2） were checked before giving the anaesthetic,before the examination under anesthesia,during the examination,completely conscious from anesthesia and 24 h after the examination.The adverse reaction and analepsia time were recoded.Oxygen was given by nasal catheter during the examination.Results After giving anaesthetic,the systolic pressure（SP）,diastolic pressure（DP） and HR tended to go down significantly in patients of group A and group B compared with those recorded before giving anaesthetic.Only group B showed significance in RR and SpO2 before the examination and after giving anaesthetic.For RR and SpO2 there were no significant difference between the two groups during the examination and after becoming completely conscious.There were no significant difference in HR,SP,DP,RR and SpO2 before vs.24 h after the examination.The time of palinesthesia and adverse reaction were similar in both groups.Conclusion Under careful monitoring it is relatively safe to perform painless bronchoscopy for elderly patients with pulmonary dysfunction.Attention should be paid to respiratory depression and respiratory management should be strengthened early.