阿芬太尼复合咪达唑仑用于纤维支气管镜检查的镇静效果

Efficacy of alfentanil combined with midazolam in fiberoptic bronchoscopy sedation

目的评价阿芬太尼复合咪达唑仑用于纤维支气管镜(纤支镜)检查的镇静效果及安全性。方法选择择期镇静麻醉下行纤支镜检查患者200例,随机分为5组(n=40)。麻醉诱导均给予咪达唑仑0.04 mg·kg^(-1),MF组复合芬太尼1μg·kg-1,MA1、MA2、MA3、MA4组分别复合阿芬太尼10、15、20、25μg·kg-1,且每组均常规给予2%利多卡因表面麻醉。记录各组的平均动脉压(MAP)和心率(HR),检查过程中的呛咳反应、低氧及不良反应发生情况,术后随访术中痛苦回忆发生情况和患者愿意再次检查的接受率。结果与MF组比较,MA组纤支镜通过声门进入主支气管时患者的MAP和HR波动较小、术中呛咳程度较低(P<0.01)、愿意再次检查的接受率较高(P<0.01),低氧的发生率虽多随阿芬太尼剂量的增加有所上升,但未见显著差异(P>0.05)。与MA1组比较,MA2、MA3和MA4组的术中呛咳程度显著降低(P<0.05),但MAP和HR波动、术中痛苦回忆发生情况、愿意再次检查的接受率均未见显著差异(P>0.05)。结论阿芬太尼复合咪达唑仑可为成人纤支镜检查提供较好的镇静麻醉效果,改善循环波动,减轻术中呛咳,提高患者愿意再次检查的接受率,但低氧的发生风险不容忽视。

AIM To evaluate the safety and efficacy of alfentanil combined with midazolam in fiberoptic bronchoscopy sedation.METHODS Two hundred patients scheduled for painless fiberoptic bronchoscopy were assigned randomly into five groups(n=40):group MF(control group)combined with fentanyl(1μg·kg-1)administration 2 minutes after midazolam(0.04 mg·kg-1)injection;group MA1,MA2,MA3,MA4 combined with alfentanil 10,15,20,25μg·kg^(-1)administration 2 minutes after midazolam(0.04 mg·kg-1)injection,respectively.Each group was routinely given 2%lidocaine for topical anesthesia.Clinical data including mean arterial pressure(MAP)and heart rate(HR),coughing reaction,hypoxia,and adverse reactions during the examination,the occurrence of painful recall during the postoperative follow-up,and the patient’s willingness to return were also recorded and compared.RESULTS Compared with the group MF,the MAP and HR expressed less fluctuation when the bronchoscope entered the principal bronchus in the group MA,with lower visual analogue scale(VAS)scores on coughing reaction(P<0.01)and higher willingness to return(P<0.01).Although the incidence of hypoxia has increased with increasing dosages of alfentanil,there were no significant statistical differences in hypoxia among the five groups(P>0.05).Significantly lower VAS scores on coughing reaction were reported in the group MA2,MA3 and MA4 when compared with group MA1(P<0.05),but no significant statistical differences were observed in the fluctuation of MAP and HR,the occurrence of painful recall and the willingness to return(P>0.05).CONCLUSION Alfentanil combined with midazolam can provide better sedative effects for adult fiberoptic bronchoscopy,ameliorate circulation fluctuation,reduce coughing reaction,improve the willingness to return,but the risk of hypoxia is worthy of attention.