右美托咪定在高龄患者纤维支气管镜检查中效果

Dexmedetomidine in fiberoptic bronchoscope examination for elderly patients

目的观察右美托咪定用于高龄患者纤维支气管镜检查的临床效果。方法选择2016年5—12月解放军307医院行纤维支气管镜检查的高龄患者80例为研究对象,采用随机数字表法分为A组(n=40)与B组(n=40)。两组患者入室后鼻咽部均行1%丁卡因溶液表面麻醉。B组依次采用右美托咪定、咪达唑仑、地佐辛镇静镇痛,行丁卡因气管内麻醉,配合丙泊酚静脉麻醉进行纤维支气管镜检查。A组以等容量生理盐水替代右美托咪定静注,其余方法与B组相同。记录静注右美托咪定时(T_0)、静注咪达唑仑时(T_1)、环甲膜穿刺时(T_2)、声门进镜即刻(T_3)、术中(T_4)、苏醒(T_5)时间点的心率(HR)、收缩压(SBP)、脉搏氧饱和度(Sp O_2);T_2时间点Ramsay镇静评分、术中麻醉效果、术者满意度、患者满意度及不良反应发生率。结果T_1~T_5时间点,B组的HR低于A组,两组比较,差异有统计学意义(P<0.05);两组SBP、Sp O_2比较,差异无统计学意义(P>0.05)。T_2时间点,B组Ramsay镇静评分、术中麻醉效果、术者满意度及患者满意度均优于A组,不良反应发生率低于A组,差异有统计学意义(P<0.05)。B组患者丙泊酚总用量明显少于A组,差异有统计学意义(P<0.05)。两组患者苏醒时间比较,差异无统计学意义(P>0.05)。结论右美托咪定用于高龄患者纤维支气管镜检查安全可行,血流动力学稳定、麻醉效果佳,不良反应少。

Objective To investigate the clinical effects of dexmedetomidine in fiberoptic bronchoscope examination for elderly patients.Methods A retrospective study was performed on 80 cases of patients who were admitted and underwent fiberoptic bronchoscope examination from May to December 2016.Patients were randomly divided into Group A（n=40）and Group B（n=40）.All patients underwent surface anesthesia in throat with 1%tetracaine solution.In Group B,dexmedetomidine,midazolam,dezocine were infused in turn for sedation and analgesia.Anesthesia in tracheal endotracheal,and propofol intravenous anesthesia before fiberoptic bronchoscope examination.In Group A,dexmedetomidine was instead of the same volume of saline,the remaining methods were the same as that in Group B.The heart rate（HR）,systolic blood pressure（SBP）,pulse oxygen saturation（Sp O_2）were recorded at the time of infusingdexmedetomidine（T_0）,time of infusing midazolam（T_1）,time of thyrocricocentesis（T_2）,time of bronchoscope into the glottis（T_3）,during the operation（T_4）and revive（T_5）.Ramsay sedation score,effect of perioperative anesthesia,satisfaction of surgeon and patients and adverse reactions at T_2were also recorded.Results From T_1to T_5,the HR of Group B was lower than that in Group A,and the difference was statistically significant（P〈0.05）.There was no statistically significant difference of SBP and Sp O_2between the two groups（P〈0.05）.At T_2,Ramsay sedation score,effect of perioperative anesthesia,satisfaction of surgeon and patients of Group B were all superior to those of Group A,the adverse reactions in Group B were less than those in Group A（P〈0.05）.The usage of propofol in Group B was significantly less than that in Group A（P〈0.05）.The revive time had no statistically significant difference between the two groups（P〈0.05）.ConclusionEffect of dexmedetomidine used in fiberoptic bronchoscope examination for elderly patients is safe and feasible,the hemodynamic is stability,the anesthetic effect is good,and the adverse reactionsareless.