阿芬太尼复合瑞马唑仑或丙泊酚用于经鼻纤维支气管镜下气管插管的效果

Efficacy of alfentanil combined with remimazolam or propofol for endotracheal intubation under nasal fiber bronchoscope

目的 观察阿芬太尼复合瑞马唑仑或丙泊酚用于经鼻纤维支气管镜下气管插管的效果。方法 行颈椎前路减压植骨融合内固定手术的患者60例随机均分为阿芬太尼复合瑞马唑仑(R)组和阿芬太尼复合丙泊酚(P)组。两组静脉注射阿芬太尼10μg/kg;1 min后,R组静脉注射瑞马唑仑0.3 mg/kg,P组静脉注射丙泊酚1.5 mg/kg。改良警觉/镇静评分≤3分时,立即行经鼻纤维支气管镜下气管插管。记录麻醉给药前(T1)、置入纤维支气管镜即刻(T2)、置入气管导管即刻(T3)和置入气管导管后1 min(T4)时的HR、MAP和SpO_(2)。评估T2、T3和T4时的耐受度评分。观察两组不良反应发生情况。结果 与P组比较,R组T2、T3、T4时的HR增快和MAP升高,T3、T4时SpO_(2)升高(P<0.05)。两组T2、T3、T4时耐受度评分相仿(P>0.05)。与P组比较,R组呼吸抑制、SpO_(2)变化率≥5%、MAP变化率≥20%和HR变化率≥20%发生率降低(P<0.05)。结论 与阿芬太尼复合丙泊酚比较,阿芬太尼复合瑞马唑仑用于经鼻纤维支气管镜下气管插管对呼吸和循环影响较轻。

Objective To observe theefficacy of alfentanil combined with remimazolam or propofol for endotracheal intubation under nasal fiber bronchoscope,Methods Sixty patients undergoing anterior cervical decompression and bone grafting fusion internal fixation were randomly divided into two groups with 30 cases each.One minute after intravenous injection of alfentanil 10μg/kg,group R was injected with remimazolam O.3 mg/kg and group P was injected with propofol 1.5 mg/kg.When the score of modified observer's assessment of alertness-sadation≤3 points,endotracheal intubation under nasal fiber bronchoscopewas performed immediately.HR,MAP and SpO_(2) were recorded at the time points of before anesthesia administration(T1),immediately after bronchoscopy implantation(T2),immediately after tracheal intubation(T3),and one minute after tracheal intubation(T4).The tolerance scores at T2,T3 and T4 were evaluated.The occurrence of adverse reactions was observed.Results Compared with group P,HR and MAP in group R were increased at T2,T3 and T4,and SpO_(2) was increased at T3 and T4(P<0.05).There was no significant difference in the tolerance scores at T2,T3 and T4 between the two groups(P>0.05).Compared with group P,group R had less incidence rates of respiratory depression,SpO_(2) change rate≥5%,MAP change rate≥20%and HR change rate≥20%(P<0.05).Conclusion Compared to combined use of alfentanil and propofol,combined use of alfentanil and remimazolam for endotracheal intubation under nasal fiber bronchoscope has less effect on respiration and circulation.