不同剂量氢吗啡酮及舒芬太尼用于无痛支气管镜检查的随机对照研究

A randomized controlled study of different doses of hydromorphone and sufentanil for painless bronchoscopy

目的探讨不同剂量氢吗啡酮复合丙泊酚麻醉应用于无痛支气管镜检查术的有效性和安全性。方法选择无痛支气管镜检查患者80例，随机分为舒芬太尼组（SF组）、低剂量氢吗啡酮组（5μg/kg，Hl组）、中剂量氢吗啡酮组（10μg/kg，H2组）、高剂量氢吗啡酮组（15μg/kg，H3组），每组20例。比较4组诱导前（Tn）、诱导后lrain（T0）、纤维支气管镜检查操作时（T1）、术毕时（T1）平均动脉压（mean arteri alpressure，MAP）、心率（heart rate，HR）、脉搏血氧饱和度（pulse oxygen saturation，SpO2）、呼吸频率（respiratory rate，RR），记录手术时间、苏醒时间、内镜医生与麻醉医生对麻醉效果的满意评分、苏醒时呼吸道痛视觉模拟评分（visual analogue scale，VAS），观察术中体动和呛咳、低氧血症、术后呕吐和头晕、皮肤瘙痒不良反应情况。结果T，～T1时Hl组MAP、HR明显高于SF组、H2组、H3组（P〈0．05）；T1时SF组、H3组RR、SpO2明显低于Hl组、H2组（P〈0．05）；SF组苏醒时间明显长于Ⅲ组、H2组、H3组（P〈0．05），H2组麻醉医生满意评分明显高于SF组、Ⅲ组、H3组（P〈0．05），Hl组VAS明显高于SF组、H2组、H3组（P〈0．05）nHl组术中体动和呛咳发生率明显高于SF组、H2组、H3组（P〈0．05），Ⅲ组、H2组术中低氧血症、术后呕吐和头晕发生率明显低于SF组、H3组（P〈0．05），SF组皮肤瘙痒发生率明显高于Hl组、H2组、H3组（P〈0．05）。结论10μg/kg氢吗啡酮复合丙泊酚静脉麻醉下行支气管镜检查，术中呼吸循环稳定、术后苏醒快、不良反应发生率低。

Objective To determine the efficacy and safety of varied concentrations of hydro-morphone plus propofol sedation in bronchoscopy. Methods Eighty consecutive patients undergoing bronchoscopy were randomly allocated to receive sufentanil or varied concentrations of hydromor-phone (5μg/kg, 10μg/kg or 15μg/kg) with 20 patients in each group. MAP, HR, SpO2 and RR were compared among groups before anesthesia induction ( T0 ) , 1 min post induction ( T1 ) , intra-operative period ( T2 ) and at the end of procedure ( T3 ) . Duration of operation, recovery times, VAS and satisfaction ratings were recorded. Intraoperative movement and cough, hypoxemia, postope-rative vomitting, dizziness, and pruritus were monitored and compared among groups. Results At the time point of T2 and T3 , MAP and HR were higher in H1 group compared with SF, H2 or H3 group. RR and SpO2 were lower in SF and H3 groups than those in the H1 and H2 groups at T1 . There was a longer recovery time in SF group compared with H1, H2 or H3 group. Anesthetist satis-faction score was higher in H2 group than that in SF, H1 or H3 group, and VAS score was signifi-cantly higher in H1 group comparison with SF, H2 or H3 group. There was a lower incidence of intra-operative movement and cough in H1 group. The incidence of hypoxemia, postoperative vomitting and dizziness was significantly lower in H1 and H2 groups. SF group had a significantly higher inci-dence of postoperative pruritus than that in H1, H2 or H3 group. Conclusion Propofol plus 10μg/kg hydromorphone sedation was safe and feasible with stable circulation, lessened recovery time and decreased postoperative complications in patients undergoing flexible bronchoscopy.