右美托咪啶与咪达唑仑在电子支气管镜检查中随机双盲研究

Randomized double-blind study of dexmedetomidine and midazolamfor electronic bronchoscopy

目的评估右美托咪啶联合芬太尼与咪达唑仑联合芬太尼在电子支气管镜镇静中的临床应用价值比较。方法选择年龄在18～70岁、美国麻醉医师协会（ASA）分级1～3级的电子支气管镜检查患者52例进行前瞻性双盲研究，随机分为右美托咪啶组（右美托咪啶＋芬太尼，D组）26例和咪达唑仑组（咪达唑仑＋芬太尼，M组）26例。记录患者一般资料，麻醉前（T0）、进鼻腔时（T1）、过声门时（T2）、过声门后1min（T3）、3min（T4）、5min（T5）的平均动脉压（MAP）、心率（HR）和SpO2，镜检中情况、镜检时间及复苏时间，术后调查患者满意度。结果D组HR在T1、T2、T3、T4、T5低于M组，差异有统计学意义（P〈0．05），T0两组差异无统计学意义（P〉0．05）；D组spoz在T1、T2、T3、T4、T5高于M组，差异有统计学意义（P〈0．05），T1两组差异无统计学意义（P〉0．05）。镜检过程中D组追加芬太尼人次、出现低氧血症人次均少于M组，差异有统计学意义（P〈0．05）；使用阿托品或异丙肾上腺素人次两组差异无统计学意义（P〉0．05）。D组患者镜检过程满意度较M组高，差异有统计学意义（P〈0．05）；镜检时间、复苏时间两组差异无统计学意义（P〉0．05）。结论右美托咪啶合并芬太尼在电子支气管镜检查中相比咪达唑仑合并芬太尼具有呼吸抑制不明显，患者舒适度高的优点，而对镜检和复苏时间影响不明显。

Objective To compare the clinical value of dexmedetomidine combined with fentanyl wersus midazolam combined with fentanyl for sedation in electronic bronchoscopy. Methods This randomized double-blind prospective study was conducted on a total of 52 patients aged 18-70 in American Society of Anesthesiologists（ASA） grade 1-3 scheduled for elective electronic bronchoscopy who were randomly allocated into two groups：Group D （ n=26） received dexmedetomidine combined with fentanyl and Group M （n=26） received midazolam combined with fentanyl. General data of patients; Mean arterial pressure（MAP）, heart rate（HR） and oxygensaturation （SpO2） at six time points （T0, baseline; T1 ,passage of the bronchoseope through nasal cavity; T2, passage of the bronchoscope through vocal cords;T3, I rain after T1 ; T4 , 3 min after T1; T5, 5 min after T1） ; satisfaction scores of patients, examination matters, examination time and recovery time were recorded. Results HR in Group D was significantly lower than in Group M（ P d0.05） at T1,T2 ,T3 ,T4 ,T5 while SpO2 was exactly the reverse. There were no significant differences between groups at To in terms of HR and SpO2. The eases of fentanyl requirements and hypoxemia occurrence in Group D were significantly less than in Group M （ P〈0.05） while the satisfactionrate was exactly the reverse. There were no significant differences between groups in cases of atropine or epinephrine syringe and in duration of examination and recovery. Conclusions Compared to midazolam, dexmedetomidine combined with fentanyl could be associated with less desaturation and higher patients satisfaction in patients detected by the electronic bronchoscopy. However, the examination and recovery time could be similar.