阻塞性睡眠呼吸暂停综合征患者靶控不同浓度舒芬太尼行纤维支气管镜经鼻气管插管镇静效果的比较

The sedation effect of different doses of sufentanil TCI during fiberoptic bronchoscopy nasal intubation in obstructive sleep syndrome patients

目的不同血浆靶控浓度舒芬太尼对阻塞性睡眠呼吸暂停综合征（OSAS）患者纤维支气管镜（FOB）经鼻气管插管镇静效果的比较。方法 OSAS患者45例,性别不限,年龄28-60岁,体质量80-110 kg,ASA分级Ⅱ或Ⅲ级。采用随机数字表法,将其分为3组（n=15）：对照组（C组）、舒芬太尼血浆靶浓度0.4 ng/mL组（S-Ⅰ组）和舒芬太尼血浆靶浓度0.6 ng/mL组（S-Ⅱ组）。2%利多卡因混合1%丁卡因咽喉喷雾表面麻醉,环甲膜穿刺注射1%丁卡因3 mL。各组达血浆靶浓度后开始实施纤维支气管镜（FOB）引导经鼻气管插管。记录麻醉诱导开始至气管插管后3 min MAP和HR变化率。SPO2、PI（灌注指数）及Ramsay镇静评分。并记录插管时不良反应发生情况。结果 S-Ⅰ和S-Ⅱ组MAP变化率〉30%及HR变化率〉30%显著低于C组（P〈0.05）。SPO2：S-Ⅱ组T1显著低于T0（P〈0.05）,且与C与S-Ⅰ组比较差异有显著性（P〈0.05）;PI：S-Ⅰ和S-Ⅱ组T1-4与T0比较均显著增高（P〈0.05）,组间比较S-Ⅰ和S-Ⅱ组T1-3与C组差异有显著性（P〈0.05）;Ramsay：S-Ⅰ和S-Ⅱ组T1-4时刻均显著高于T0（P〈0.05）,组间两两比较差异均有显著性（P〈0.05）。不良反应发生情况：憋气、呛咳及恶心发生率C组均显著高于S-Ⅰ、S-Ⅱ组,插管知晓各组间差异（P〈0.05）均有显著性。结论阻塞性睡眠呼吸暂停综合征患者舒芬太尼血浆靶控浓度为0.4 ng/mL时纤维支气管镜引导经鼻气管插管血流动力学稳定、镇静满意且无呼吸抑制作用。

【Objective】To compare the sedative effect of different dosage of sufentanil TCI during fiberoptic bronchoscopy（FOB） nasal intubation in obstructive sleep apnea hypopnea syndrome（OSAS） patients. 【Methods】45 ASA, Ⅱor Ⅲ patients with OSAS, aged 28-60 year, weight 80-110 kg, scheduled for elective surgery, were randomly assigned three groups（n =15 each）： control group（group C） and sufentanil target plasma concentration 0.4 ng/ mL（groupS-Ⅰ）, 0.6 ng/mL（group S-Ⅱ）. Both groups were pretreated with 2% lidocaine plus 1% tetracaine throat spray for topical anesthesia, 1% tetracaine 3 mL to cricothyroid membrane injection. FOB was started after every group reached target plasma concentrations nasal intubation, the 30% changes of MAP and HR relative to baseline values were calculated. and SPO2, PI（perfusion index）, Ramsay sedation score were recorded, at the same time intubation adverse events were evaluated.【Results】The incidences of MAP and HR percent changed30% of the base-line, decreased significantly in group S-Ⅰ, S-Ⅱ; SPO2： S-Ⅱ group T1 significantly lower than T0（P〈 0.05）, and had significant differences with C and S-Ⅰ group（P〈 0.05）; PI： S-Ⅰ and S-Ⅱ group T1-4 compared with T0 were significantly increased, S-Ⅰand S-Ⅱ group T1-3 were significant higher than group C（P〈 0.05）; Ramsay sedation score： S-Ⅰ, S-Ⅱ group T1-4 was significantly higher than T0（P〈 0.05）, and there was a significantly difference between groups（P〈 0.05）.【Conclusion】During FOB nasal intubation sufentanil TCI 0.4ng/ml has the advantage of hemodynamic stability, sedation better and no respiratory depression in patients with OSAS.