右美托咪定联合瑞芬太尼放置鼻咽通气道在无痛纤维支气管镜中的应用

Application of Dexmedetomidine combined with Remifentanil in nasopharyngeal airway placement in painless fiberbronchoscopy

目的探讨右美托咪定联合瑞芬太尼放置鼻咽通气道在无痛纤维支气管镜中的应用。方法选取2019年1~7月宜春市人民医院收治的60例行纤维支气管镜检查者作为研究对象,按照经随机抽签法将其分为对照组和观察组,每组各30例。两组均行右美托咪定联合瑞芬太尼麻醉,对照组予以喉罩麻醉,观察组经鼻咽通气道麻醉,比较两组不同阶段血流动力学、手术时间、疼痛评分、呼吸抑制次数和不良反应发生率。结果两组麻醉前(T0)、纤支镜进入声门(T1)血流动力学指标比较,差异无统计学意义(P>0.05),两组患者开始纤支镜检查即刻(T2)、纤支镜抵达隆突即刻(T3)、纤支镜检查完成即刻(T4)平均动脉压、心率、呼吸频率和血氧饱和度低于T0,差异有统计学意义(P<0.05)。观察组T2~T4平均动脉压和血氧饱和度高于对照组,差异有统计学意义(P<0.05);观察组的疼痛评分及不良反应总发生率低于对照组,呼吸抑制次数少于对照组,差异有统计学意义(P<0.05);两组的手术时间比较,差异无统计学意义(P>0.05)。结论在无痛纤维支气管镜中经鼻咽通气道给氧,可减少血流动力学指标波动,缓解呼吸抑制和疼痛感作用明显,减少不良反应,值得推广。

Objective To investigate the application of Dexmedetomidine combined with Remifentanil in nasopharyngeal airway placement in painless fiberoptic bronchoscope.Methods A total of 60 patients undergoing fiberoptic bronchoscopy in Yichun People′s Hospital from January to July 2019 were selected as the research subjects.According to random drawing,they were divided into control group and observation group,with 30 cases in each group.Both groups were treated with Dexmedetomidine combined with Remifentanil anesthesia,the control group was treated with laryngeal mask anesthesia,and the observation group was treated with nasopharyngeal airway anesthesia.The hemodynamics,operative time,pain score,frequency of respiratory depression and incidence of adverse reactions in different stages were compared between the two groups.Results There was no statistically significant difference in hemodynamic indexes between the two groups of before anesthesia(T0),bronchoscopy mirror into the glottis(T1)(P>0.05),the average arterial pressure,heart rate,respiratory rate and blood oxygen saturation of batients started bronchoscopy immediatdy(T2)bronchoscopy mirror arrived bulge immediately(T3),fiber mirror check completed immediately(T4)of the two groups were lower than T0,and the differences were statistically significant(P<0.05).The observation group T2~T4 mean arterial pressure and oxygen saturation was higher than the control group,the difference was statistically significant(P<0.05).The pain score and the total incidence of adverse reactions in the observation group were lower than those in the control group,and the number of respiratory depression was lower than that in the control group,and the differences were statistically significant(P<0.05).There was no significant difference in operation time between the two groups(P>0.05).Conclusion In painless fiberoptic bronchoscope,oxygen delivery through nasopharyngeal airway can reduce the fluctuation of hemodynamic indexes,relieve respiratory depression and pain,and reduce adverse reactions,which is worthy of promotion.