阿芬太尼复合丙泊酚在无痛纤维支气管镜检查中的镇静效果

Sedative Effect of Alfentanil Combined with Propofol in Painless Fiberoptic Bronchoscopy

目的观察阿芬太尼复合丙泊酚在无痛纤维支气管镜检查(FB)中的镇静效果。方法选取2023年3—4月在贵州航天医院拟行无痛FB的82例患者,采用计算机随机编号法将纳入患者分为阿芬太尼组和舒芬太尼组。阿芬太尼组予以阿芬太尼8μg/kg复合2 mg/kg丙泊酚完成麻醉诱导,舒芬太尼组予以0.08μg/kg舒芬太尼,其余操作同阿芬太尼组。记录并比较两组镇静效果(麻醉起效时间、丙泊酚追加例数、呛咳反应、体动反应、苏醒时间、苏醒时Ramsay评分),不同时点(麻醉前、麻醉后、纤维支气管镜过声门时、纤维支气管镜过声门后1 min、纤维支气管镜过声门后3 min、检查结束时)平均动脉压(MAP)、心率、经皮脉搏血氧饱和度(SpO_(2))以及不良反应发生情况,评估并比较两组医师满意度和患者满意度。结果检查前,2例患者退出,最终纳入80例患者,阿芬太尼组和舒芬太尼组各40例。与舒芬太尼组比较,阿芬太尼组麻醉起效时间、苏醒时间明显缩短(P<0.01),且呛咳控制不佳例数更少、苏醒时Ramsay评分更低(P<0.05或P<0.01)。各时点间MAP、心率的主效应差异有统计学意义(P<0.01),SpO_(2)差异无统计学意义(P>0.05);不考虑测量时间,两组间心率的主效应差异有统计学意义(P<0.01),MAP、SpO_(2)差异无统计学意义(P>0.05);MAP、心率的时点间与组间存在交互作用(P<0.05或P<0.01),SpO_(2)的时点间与组间不存在交互作用(P>0.05),两组各时点MAP、心率、SpO_(2)的变化幅度不同。纤维支气管镜过声门时,阿芬太尼组的MAP、心率低于舒芬太尼组[(103±16)mmHg(1 mmHg=0.133 kPa)比(116±17)mmHg,(79±9)次/min比(97±14)次/min](P<0.05);与麻醉前比较,纤维支气管镜过声门时阿芬太尼组SpO_(2)降低(P<0.05),舒芬太尼组心率升高、SpO_(2)降低(P<0.05),其余时点两组MAP、心率、SpO_(2)比较差异均无统计学意义(P>0.05)。术后24 h,阿芬太尼组恶心发生率低于舒芬太尼组(P<0.05)。阿芬太尼组医师满意度高于舒芬太尼组(P<0.05);术后1 d,两组患者满意度均为满意。结论阿芬太尼与舒芬太尼复合丙泊酚在无痛FB中的镇静效果满意,且阿芬太尼复合丙泊酚的麻醉起效更快、术后患者苏醒时间更短,且患者术中血流动力学较平稳,不良反应少。

Objective To observe the sedative effect of alfentanyl combined with propofol in painless fiberoptic bronchoscopy(FB).Methods A total of 82 patients who planned to receive painless FB in Guizhou Aerospace Hospital from Mar.2023 to Apr.2023 were included and divided into an alfentanil group and a sufentanil group by computer random numbering method.The alfentanil group was given 8μg/kg of alfentanil combined with 2 mg/kg of propofol to induce anesthesia;the sufentanil group was given 0.08μg/kg of sufentanil,and the other operations were the same as the alfentanil group.The sedation effects(onset time of anesthesia,number of propofol additions,cough response,somatokinetic response,recovery time,Ramsay score upon recovery),mean arterial pressure(MAP),heart rate,percutaneous pulse oxygen saturation(SpO_(2))at different time points(before anesthesia,after anesthesia,when fiberbronchoscope passed through the glottis,1 min and 3 min after fiberbronchoscope passed through the glottis),and occurrence of adverse reactions of the two groups were recorded and compared,and the physician satisfaction and patient satisfaction were assessed and compared between the two groups.Results Before examination,2 patients dropped out,and eventually 80 patients were included,40 in the alfentanil group and 40 in the sufentanil group.Compared with the sufentanil group,anesthesia onset time and recovery time in the alfentanil group were significantly shortened(P<0.01),and there were fewer cases of poor cough control and lower Ramsay score at recovery(P<0.05 or P<0.01).The main effect differences of MAP and heart rate were statistically significant(P<0.01),while the difference of SpO_(2)was not statistically significant(P>0.05).Regardless of the measurement time,the main effect difference of heart rate between the two groups was statistically significant(P<0.01),but the differences of MAP and SpO_(2)were not statistically significant(P>0.05).There were interactions in MAP and heart rate between time points and groups(P<0.05 or P<0.01),while there was no such interaction in SpO_(2)(P>0.05).The change amplitudes of MAP,heart rate and SpO_(2)between time points of the two groups were different.The MAP and heart rate when the fiberbronchoscope passed through the glottis in the alfentanil group were lower than those in the sufentanil group[(103±16)mmHg(1 mmHg=0.133 kPa)vs(116±17)mmHg,(79±9)beats/min vs(97±14)beats/min](P<0.05).Compared with before anesthesia,when the fiberbronchoscope passed through the glottis,SpO_(2)in the alfentanil group decreased(P<0.05),while the heart rate increased and SpO_(2)decreased in the sufentanil group(P<0.05),and there were no statistically significant differences in MAP,heart rate and SpO_(2)between the two groups at other time points(P>0.05).The incidence of nausea 24 h after operation in the alfentanil group was lower than the sufentanil group(P<0.05).The physician satisfaction in the afentanil group was higher than that in the sufentanil group(P<0.05).1 day after operation,the patient satisfaction of both groups was satisfactory.Conclusion The sedation effect of alfentanil or sufentanil combined with propofol in painless FB was satisfactory,and alfentanil combined with propofol has faster onset,shorter postoperative recovery time,as well as stable patient intraoperative hemodynamics and fewer adverse reactions.