丙泊酚用于重症患者纤维支气管镜检查治疗的临床观察

Clinical Observation of the Propofol in Fiber Bronchoscope Treatment Patients with ICU

目的探讨丙泊酚用于重症患者纤维支气管镜检查治疗中的有效性、安全性及对血流动力学的影响。方法选择我科需要行纤支镜检查治疗的重症患者66例,随机分为试验组（P组）和对照组（L组）,每组33例。L组在检查治疗前先给予2%利多卡因1-2 mL气管内表麻后静脉推注0.9%氯化钠2-5 mL,1 min后进镜行纤支镜检查治疗;P组在给予2%利多卡因1-2 mL气管内表麻后静脉推注丙泊酚（阿斯特拉捷利康公司）0.3-1.0 mg/kg（约2-5 mL）,1 min后进镜行纤支镜检查治疗,观察两组患者基础值、操作前、操作过程中、结束后10 min各个时间点的血压、心率、血氧饱和度及呛咳、憋气、肢体扭动等指标。结果 P组在检查治疗中的SBP、DBP、HR,与L组相比有显著性差异（P〈0.05）;患者出现咳嗽、憋气、肢体扭动的也较少,其发生率分别为P组15.2%、6.1%、3%,L组90.9%、72.7%、63.6%;两组比较有显著性差异（P〈0.05）。结论丙泊酚应用于重症患者纤维支气管镜检查治疗具有良好的镇静作用,能减轻或消除纤维支气管镜检查治疗所引起的剧烈呛咳、心率加快、血压升高等应激反应,增强患者检查治疗的安全性及成功率。

Objective To discusses the effect, safety and the influence to hemodynamics ofpropofol using in fiber bronchoscope to severe eases. Method Randomly divided 66 cases that need fiber bronchoscope in to 2 groups. P group for treatment group and L group for control group. Each group had 33 cases. For L group, every patient received 2% lidocaine for intratracheal topical anesthesia and then receives an intravenous injection of 0.9% sodium chloride solution 1 minute prior to fiber bronchoscope. For P group, every patient received 2% lidocaine for intratracheal topical anesthesia and then receives an intravenous injection of propofol 1 minute prior to fiber bronchoscope. We observed the blood pressure, oxygen saturation, bucking suffocates and wiggles during the operation, immediately after the operation and 10 minutes after the operation of the patient. Result The P group had a significant reduced SBP, DBP, HR （P〈0.05）, and the bucking suffocates and wiggles are significant reduced in the P group when comparing to the L group （P〈0.05）. Conclusion Propofol is a effective sedative during the sedative fiber bronchoscope. It can reduce the BP, HR, bucking during the operation and improve the effect safety of the examination.