地佐辛配伍丙泊酚联合喉罩用于纤维支气管镜检查的临床研究

Clinical Observation of Propofol Combined with Dezocine and Laryngeal Mask Airway for Fiberoptic Bronchoscopy

目的 评价地佐辛配伍丙泊酚联合喉罩用于无痛纤维支气管镜检查的效果。 方法 将2012年10月－12月拟行纤维支气管镜检查，且按美国麻醉医师协会分级Ⅰ或Ⅱ级的60例患者，随机分为芬太尼组（F组）、地佐辛组（D组）、生理盐水组（N组）,每组20例。采用双盲法给药，静脉注射芬太尼（10 μg/mL）或地佐辛（1 mg/mL）或生理盐水0.1 mL/kg，5 min后3组缓慢静脉注射丙泊酚2 mg/kg诱导后置入喉罩，术中保留自主呼吸，持续泵入丙泊酚4～6 mg/（kg·h）维持麻醉，观察3组患者诱导前（T0）、诱导后时（T1）、纤维支气管镜操作时（T2）、术毕时（T3）及拔除喉罩时（T4）的生命体征，记录丙泊酚总用量、苏醒时间、苏醒时的呼吸道疼痛视觉模拟评分（VAS），记录术中及术后有关并发症的发生情况。 结果 与N组相比，D、F两组丙泊酚总用量减少、苏醒时间缩短，头昏及术中体动发生率、VAS评分明显降低（P＜0.05）；呼吸暂停的发生率D组最低（P＜0.05）；恶心、呕吐的发生率F组最高（P＜0.05）。 结论 地佐辛配伍丙泊酚联合喉罩用于无痛纤维支气管镜检查，麻醉效果满意，术后镇痛效果好，值得临床推广。

Objective To evaluate the effects of propofol combined with dezocine and laryngeal mask airway for fiberoptic bronchoscopy treatment. Methods From October to December, 2012, 60 patients with American Sociaty of Anesthesiology grade I or II undergoing fiberoptic bronchoscopy were randomly divided into three groups with 20 patients in each： group F （propofol ＋ fentanyl）, group D （propofol ＋ dezocine）, and group N （propofol ＋ physiological saline）. The patients received one of the three anesthetic combinations in double-blind fashion. Five minutes after fentanyl （10 μg/mL） or dezocine （1 mg/mL） or physiological saline （0.1 mL/kg） was injected intravenously, all patients were given propofol injection for induction （2 mg/kg） and maintenance [4-6 mg/（kg · h）]. The laryngeal mask airway was inserted. Fiberoptic hronchoscopy was performed. The patients breathed spontaneously. All patients＇ vital signs were observed at five time points： before anesthesia induction （T0）, after anesthesia induction （T1）, during surgery （T2）, the end of operation （T3） and removal of laryngeal mask airway （T4）. The total amounts of propofol, recovery time, and visual analogue scale （VAS） score of pain after consciousness were recorded. Intraoperative complications and postoperative complications were also recorded. Results The total amount of propofol and recovery time of group F and D were significantly reduced compared with group N （P 〈 0.05）. The incidences of intraoperative body movement, postoperative dizziness, VAS score of pain after consciousness were significantly lower in group F and D than those in group N （P 〈 0.05）. The incidence of apnea was significantly lower in group D than that in group F and N （P 〈 0.05）. The incidences of postoperative nausea and vomiting were significantly higher in group F than those in group D and N （P 〈 0.05）. Conclusions Dezocine combined with propofol for fiberoptic bronchoscopy has satisfactory anesthesia effect with less respiratory inhibition and postoperative analgesia. It is worthy of clinical promotion.