高剂量右美托咪定复合瑞芬太尼在支气管结核病无痛支气管镜冷冻术中的安全性和有效性

Safety and efficacy of high-dose dexmedetomidine combined with remifentanil in painless bronchoscopic freezing of patients with bronchial tuberculosis

目的 观察高剂量右美托咪定复合瑞芬太尼在支气管结核病患者无痛支气管镜冷冻术中的安全性和有效性。方法 选取2021年1月—2022年9月聊城市传染病医院收治的支气管结核病患者120例,采用随机数字表法分为高剂量组和低剂量组,每组60例。高剂量组操作前给予右美托咪定1μg/kg泵注10 min,瑞芬太尼1μg/kg泵注2 min;低剂量组操作前给予右美托咪定0.5μg/kg泵注10 min,瑞芬太尼0.5μg/kg泵注2 min。比较2组患者无痛支气管镜冷冻术的优良率、术中指标、患者再次做气管镜意愿、内镜医师和患者满意度评分及不良事件发生情况。结果 高剂量组患者无痛支气管镜冷冻术优良率为91.67%(55/60),低剂量组患者无痛支气管镜冷冻术优良率为86.67%(52/60),差异无统计学意义(χ^(2)=0.776,P=0.378)。与高剂量组相比,低剂量组患者无痛支气管镜冷冻术诱导时间显著延长,瑞芬太尼和右美托咪定的消耗量显著降低,患者和内镜医师的满意度及患者在相同麻醉方案下重复气管镜检查和治疗的意愿均显著降低(P<0.05)。高剂量组患者咳嗽严重程度较低剂量组患者得到显著改善(P<0.05);2组患者其他不良事件发生率比较差异均无统计学意义(P>0.05)。结论 高剂量右美托咪定和瑞芬太尼可更安全有效地应用于支气管结核病患者电子支气管镜冷冻术治疗。

Objective To observe the safety and efficacy of high-dose dexmedetomidine combined with remifentanil in painless bronchoscopic freezing of patients with bronchial tuberculosis.Methods A total of 120 patients with bronchial tuberculosis admitted to Liaocheng Infectious Disease Hospital from January 2021 to September 2022 were selected and divided into high-dose group and low-dose group by random number table method,with 60 cases in each group.The high-dose group was given dexmedetomidine 1μg/kg pump for 10 min and remifentanil 1μg/kg pump for 2 min before operation.The low-dose group was given dexmedetomidine 0.5μg/kg pump for 10 min and remifentanil 0.5μg/kg pump for 2 min before operation.The distinguished achiever ratio of painless bronchoscopy,intraoperative indexes,patients′willingness to perform tracheoscopy again,endoscopist and patient satisfaction scores,and the occurrence of adverse events were compared between the two groups.Results The distinguished achiever ratio of painless bronchoscopy freezing was 91.67%(55/60)in the high-dose group and 86.67%(52/60)in the low-dose group,with no significant difference(χ^(2)=0.776,P=0.378).Compared with the high-dose group,the induction time of painless bronchoscopic freezing in the low-dose group was significantly extended,the consumption of remifentanil and dexmedetomidine was significantly reduced,and the satisfaction of patients and endoscopists and the willingness of patients to repeat tracheoscopy and treatment under the same anesthesia regimen were significantly decreased(P<0.05).The severity of cough in high-dose group was significantly improved compared with that in low-dose group(P<0.05);There was no significant difference in the incidence of other adverse events between two groups(P>0.05).Conclusion High-dose dexmedetomidine and remifentanil can be used safely and effectively in the treatment of patients with bronchotuberculosis by electronic bronchoscopy and cryotherapy.