瑞马唑仑联合瑞芬太尼用于纤维支气管镜检查及对血流动力学参数及血清Bcl-2、NOS水平的影响

Effects on hemodynamic parameters and serum Bcl-2 and NOS levels in combination with remifentanil for fiberoptic bronchoscopy examination

目的 探讨瑞马唑仑联合瑞芬太尼用于纤维支气管镜检查及对血流动力学参数及血清B淋巴细胞瘤-2(Bcl-2)、一氧化氮合酶(NOS)水平的影响。方法 前瞻性选取2021年11月至2023年3月在太原钢铁(集团)有限公司总医院麻醉科行纤维支气管镜检查的102例患者作为研究对象,按随机数字表法将其分为观察组、对照组,每组各51例。对照组麻醉方式采取丙泊酚+瑞芬太尼,观察组采取瑞马唑仑+瑞芬太尼。比较两组麻醉前、麻醉后及进入气管时血流动力学指标[平均动脉压(MAP)、心率、呼吸频率、血氧饱和度(SpO_(2))],同时评估两组麻醉前、进入气管时视觉模拟评分法(VAS)评分、镇静评分量表(Ramsay)评分以及测定血清Bcl-2、NOS水平,另外评估两组苏醒后麻醉恢复质量量表(QoR-40)评分,最后比较两组不良反应发生情况。结果 麻醉后,观察组的MAP、呼吸频率分别为(92.15±7.27) mmHg、(18.54±1.75)次/min,均高于对照组[(87.56±5.97)mmHg、(17.79±1.74)次/min],差异均有统计学意义(P<0.05)。进入气管时,观察组VAS评分为(1.75±0.25)分,低于对照组[(2.23±0.47)分],Ramsay评分为(3.24±0.45)分,高于对照组[(2.82±0.31)分],差异均有统计学意义(P<0.05)。进入气管时,观察组血清Bcl-2、NOS水平分别为(6.21±1.23)、(7.35±1.21)μg/mg,均高于对照组(3.52±0.24)、(4.26±1.31)μg/mg,差异均有统计学意义(P<0.05)。观察组恢复期QoR-40身体舒适度、社交方面、情绪方面、行为独立方面、疼痛、总分分别为(55.81±6.12)、(32.45±2.14)、(42.56±2.25)、(21.56±2.14)、(33.41±1.12)、(185.79±13.77)分,均高于对照组[(51.23±5.75)、(28.56±2.68)、(38.12±2.56)、(18.59±2.68)、(29.56±2.14)、(166.06±15.81)分],差异均有统计学意义(P<0.05)。观察组的不良反应总发生率为11.76%,低于对照组(27.45%),差异有统计学意义(P<0.05)。结论 瑞马唑仑联合瑞芬太尼纤维支气管镜检查不仅有利于维持患者血流动力学的稳定,还能改善其血清Bcl-2、NOS水平以及提高麻醉恢复期的恢复质量,安全性较高。

Objective To explore the effects on hemodynamic parameters and serum levels of B-lymphomatoma-2(Bcl-2) and nitric oxide synthase(NOS) in combined with remifentanil for fiberoptic bronchoscopy examination.Methods A total of 102 patients who underwent fiberoptic bronchoscopy examination at the Department of Anesthesia,General Hospital of Taiyuan Steel(Group) Co.,Ltd.from November 2021 to March 2023 were prospectively selected as the study subjects.They were divided into the observation group and the control group according to the random number table method,with 51 cases in each group.The control group was anesthetized with propofol and remifentanil,while the observation group was anesthetized with remimazolam and remifentanil.The hemodynamic indicators[mean arterial pressure(MAP),heart rate,respiratory rate,and blood oxygen saturation(SpO_(2))] before anesthesia,after anesthesia,and upon entering the trachea between two groups were compared.The visual analogue scale(VAS) score and sedation scale(Ramsay) score before anesthesia and upon entering the trachea were evaluated,as well as serum Bcl-2 and NOS levels were measured.Additionally,the quality of anesthesia recovery scale(QoR-40) score after awakening between the two groups was evaluated,finally,the occurrence of adverse reactions between the two groups was compared.Results After anesthesia,the MAP and respiratory rate of the observation group were(92.15±7.27) mmHg and(18.54±1.75) beats/min,respectively,which were higher than those of the control group [(87.56±5.97) mmHg and(17.79±1.74) beats/min],and the differences were statistically significant(P<0.05).When entering the trachea,the VAS score of the observation group was(1.75±0.25) points,which was lower than that of the control group [(2.23±0.47) points],and the Ramsay score was(3.24±0.45) points,which was higher than that of the control group [(2.82±0.31) points],and the differences were statistically significant(P<0.05).When entering the trachea,the levels of serum Bcl-2 and NOS in the observation group were(6.21±1.23) and(7.35±1.21) μg/mg,respectively,which were higher than those in the control group [(3.52±0.24) and(4.26±1.31) μg/mg],and the differences were statistically significant(P<0.05).The physical comfort,social aspects,emotional aspects,behavioral independence,pain,and total score of QoR-40 in the observation group during the recovery period were(55.81±6.12),(32.45±2.14),(42.56±2.25),(21.56±2.14),(33.41±1.12),and(185.79±13.77) points,respectively,which were higher than those in the control group [(51.23±5.75),(28.56±2.68),(38.12±2.56),(18.59±2.68),(29.56±2.14),and(166.06±15.81) points],and the differences were statistically significant(P<0.05).The total incidence of adverse reactions in the observation group was 11.76%,which was lower than that in the control group(27.45%),and the difference was statistically significant(P<0.05).Conclusion The combination of remifentanil and remifentanil for fiberoptic bronchoscopy is not only beneficial for maintaining the stability of patient hemodynamics,but also for improving serum Bcl-2 and NOS levels and enhancing the quality of recovery during anesthesia recovery,with high safety.