无麻醉医师参与脑电双频指数监测下的两种清醒镇静方案在支气管镜检查中的应用效果与安全性

A comparison of the feasibility of two conscious sedation scheme as midazolam combined with dexmedetomidine and fentany guided by bispectral index during bronchoscopy

目的探讨无麻醉医师参与的脑电双频指数监测下的两种清醒镇静方案在支气管镜检查中的应用效果与安全性。方法将2018年9月至2019年7月在苏州大学医学院附属第三医院行支气管镜的患者,按照患者意愿分成局麻组(A组,利多卡因局部麻醉)和镇静组(无麻醉医师参与,BIS监测),将镇静组患者按检查顺序编号,随机分为B组(右美托咪定+咪达唑仑)和C组(芬太尼+咪达唑仑),记录不同时间点的生命体征、不良事件,术后评估镇静效果。结果共658例患者纳入研究(A组225例,B组222例,C组211例)。镇静组术者评估的过声门难易、患者评估的镇静效果均优于A组(P<0.05),B组和C组间差异无统计学意义;术者评估的咳嗽、满意度评分C组优于B组和A组(P<0.05),A组和B组间差异无统计学意义。不良事件:镇静组低氧血症、心动过缓的发生率均高于A组,高血压和心动过速的发生率低于A组,B组低氧血症发生率低于C组,心动过缓的发生率高于C组;生命体征:血压波动B组最小,A组最大;心率波动A组增加幅度大于C组,B组较操作前下降(P<0.001)。结论支气管镜检查时,和局麻相比,无麻醉医师参与、BIS指导的两种清醒镇静方案均有效、安全。两种方案相比,米达唑仑联合右美托米定较少出现低氧血症,检查前后的血压和心率波动较小,但易出现低血压和心动过缓。

Objective To investigate the feasibility of two conscious sedation regimens guided by bispectral index(BIS)without anesthesiologist involved during bronchoscopy.Methods Patients who underwent bronchoscopy in the Third Affiliated Hospital of Medical College of Suzhou University from September 2018 to July 2019,were divided into local anesthesia group(group A,lidocaine)and sedation group(BIS guided,without anesthesiologist involved)according to the patients′decision.Patients in the the sedation group were numbered according to the order of examination,randomly divided into group B(dexmedetomidine combined with midazolam)and group C(fentanyl combined with midazolam).Vital signs at different time points and adverse events were recorded during bronchoscopy.The sedation effect were evaluated by operators and patients respectively.Results A total of 658patients were in the study(225 cases in group A,222 in group B,211 in group C).The complexity of scope insertion assesed by operators and sedation effect evaluated by patients in sedation group was better than those in group A(P<0.001),while has no significant difference between group B and C;The cough VAS score,satisfaction VAS score evaluated by operators in group C were better than those in group A and B(P<0.001);As to the adverse events:the incidence of hypoxemia and bradycardia in sedation group was higher while hypertension and tachycardia was lower than that in group A.In group B,the incidence of hypoxemia was lower while that of bradycardia was higher than that in group C(P<0.001);Vital signs:The fluctuation of blood pressure was minimal in group B,and maximum in group A(P<0.001);Compared to pre-operation,the heart rate increased more in group A than that of group C,while declined in group B(P<0.001).Conclusion Compared to local anesthesia,conscious sedation guided by BIS without anesthesiologist involved was safe and effective.Compared with the two sedation protocols,dexmetomidine combined with midazolam appeared less hypoxemia,reduced the fluctuation of blood pressure and heart rate during bronchoscopy,though was prone to hypotension and bradycardia.