丙泊酚复合盐酸纳布啡或舒芬太尼麻醉用于支气管镜介入术治疗慢性阻塞性肺疾病患者中的效果比较

Comparison of effects of Propofol combined with Nalbuphine hydrochloride or Sufentanil anesthesia on patients with chronic obstructive pulmonary disease undergoing bronchoscopic interventional therap

目的:比较丙泊酚复合盐酸纳布啡或舒芬太尼麻醉在支气管镜介入术治疗慢性阻塞性肺疾病(COPD)患者中的应用效果。方法:回顾性分析2020年2月至2023年2月在信阳市第五人民医院接受经纤维支气管镜介入术治疗的82例COPD患者的临床资料,按麻醉方案不同将其分为对照组和观察组各41例。对照组采取丙泊酚复合舒芬太尼麻醉,观察组采取丙泊酚复合盐酸纳布啡麻醉。比较两组围术期指标(麻醉起效时间、苏醒时间、丙泊酚用量、术中呛咳发生率),术中平均动脉压(MAP)水平、心率,术后2、6、24 h谵妄评估量表(CAM)评分,手术前后血清氧化应激指标[过氧化氢酶(CAT)、丙二醛(MDA)、超氧化物歧化酶(SOD)]水平,以及不良反应发生率。结果:观察组苏醒时间短于对照组,丙泊酚用量少于对照组,不良反应发生率及术后2、6 h的CAM评分均低于对照组,差异均有统计学意义(P<0.05);置入支气管镜时和手术结束时,观察组MAP、心率水平均低于对照组,差异有统计学意义(P<0.05);术后1 h,两组血清MDA水平均高于术前,但观察组低于对照组,两组血清CAT、SOD水平均低于术前,但观察组高于对照组,差异有统计学意义(P<0.05)。结论:丙泊酚复合盐酸纳布啡用于支气管镜介入术治疗的COPD患者中可稳定术中血压、心率水平,减少丙泊酚用量,缩短患者术后苏醒时间,降低呛咳、术后谵妄、不良反应发生率,减轻氧化应激反应,效果和安全性优于丙泊酚复合舒芬太尼。

Objective:To compare application effects of Propofol combined with Nalbuphine hydrochloride or Sufentanil anesthesia in patients with chronic obstructive pulmonary disease(COPD)undergoing bronchoscopic interventional therapy.Methods:The clinical data of 82 patients with COPD who underwent bronchoscopic interventional in Xinyang Fifth People’s Hospital from February 2020 to February 2023 were retrospectively analyzed.They were divided into control group and observation group according to different anesthesia schemes,41 cases in each group.The control group was anesthetized with Propofol combined with Sufentanil,while the observation group was anesthetized with Propofol combined with Nalbuphine hydrochloride.The perioperative index levels(onset time of anesthesia,recovery time,Propofol dosage and incidence of intraoperative cough),the intraoperative mean arterial pressure(MAP),heart rate,the confusion assessment method(CAM)scores 2,6 and 24 h after the surgery,the serum oxidative stress index levels[catalase(CAT),malondialdehyde(MDA),superoxide dismutase(SOD)]before and after the surgery,and the incidence of adverse reactions were compared between the two groups.Results:The recovery time of the observation group was shorter than that of the control group,the Propofol dosage was less than that of the control group,the incidence of adverse reactions and the CAM scores 2 and 6 h after the surgery were lower than those of the control group,and the differences were statistically significant(P<0.05).The MAP and heart rate levels in the observation group were lower than those in the control group at the time of placement of bronchoscopy and at the end of surgery,and the differences were statistically significant(P<0.05).1 h after the surgery,the serum MDA levels of the two groups were higher than those before the surgery,but that in the observation group was lower than that in the control group;the levels of serum CAT and SOD in the two groups were lower than those before the surgery,but those in the observation group were higher than those in the control group;and the differences were statistically significant(P<0.05).Conclusions:Propofol combined with Nalbuphine hydrochloride for the patients with COPD undergoing bronchoscopic interventional therapy can stabilize the blood pressure and heart rate during the surgery,reduce the Propofol dosage,shorten the recovery time after the surgery,reduce the incidence of cough,delirium and adverse reactions,and reduce the oxidative reactions.Moreover,its anesthetic effect and safety were superior to Propofol combined with Sufentanil anesthesia.