不同靶浓度丙泊酚用于老年无痛纤维支气管镜检查患者的临床研究

Clinical trial of different target concentrations of propofol in elderly patients undergoing painless fiberoptic bronchoscopy

目的分析不同靶浓度丙泊酚与瑞芬太尼靶控输注对老年无痛纤维支气管镜检查患者的影响。方法将行无痛纤维支气管镜检查老年患者分为低剂量组、中剂量组和高剂量组。低剂量组、中剂量组和高剂量组均靶控输注注射用盐酸瑞芬太尼和丙泊酚乳状注射液,瑞芬太尼效应室靶浓度为3.0ng·mL^(-1),低、中、高剂量组丙泊酚的效应室靶浓度分别为3.0、4.0和5.0μg·mL^(-1),丙泊酚和瑞芬太尼的效应室靶浓度均达到目标靶浓度时开始检查。比较3组患者麻醉效果、麻醉质量(麻醉时间、患者舒适度及操作医师麻醉满意度)、苏醒时间和插管时间,并进行安全性评价。结果低剂量组、中剂量组和高剂量组分别入组31、36和35例。低剂量组、中剂量组和高剂量组的麻醉优良率分别为67.74%(21例/31例)、77.78%(28例/36例)和82.86%(29例/35例),中剂量组和高剂量组的上述指标与低剂量组比较,在统计学上差异均有统计学意义(均P<0.05)。低剂量组、中剂量组和高剂量组的操作医师麻醉满意度分别为(6.13±1.19)、(7.48±1.25)和(6.50±1.07)分,苏醒时间分别为(7.01±1.64)、(7.58±1.30)和(9.42±1.58)min,插管时间分别为(9.94±2.02)、(10.76±1.97)和(13.18±2.25)min,低剂量组和中剂量组的上述指标与高剂量组比较,在统计学上差异均有统计学意义(均P<0.05)。低剂量组、中剂量组和高剂量组患者麻醉时间分别为(31.18±4.26)、(29.96±5.08)和(28.74±5.43)min,舒适度分别为(8.95±0.49)、(9.03±0.41)和(9.12±0.38)分,低血压发生率分别为12.90%、5.56%和14.29%,体动发生率分别为16.13%、8.33%和5.71%,呛咳发生率分别为19.35%、13.89%和11.43%,中剂量组操作医师麻醉满意度显著高于低剂量组和高剂量组,在统计学上差异均有统计学意义(均P<0.05)。结论4.0μg·mL^(-1)效应室靶浓度丙泊酚与3.0ng·mL^(-1)效应室靶浓度瑞芬太尼靶控输注用于老年无痛纤维支气管镜检查的麻醉质量最理想,患者苏醒时间和插管时间最短,且安全性良好。

Objective To analyze the influence of target-controlled infusion with different target concentrations of propofol and remifentanil on elderly patients undergoing painless fiberoptic bronchoscopy.Methods Elderly patients undergoing painless fiberoptic bronchoscopy were divided into low-dose group,middle-dose group and high-dose group.Target-controlled infusion with remifentanil and propofol was performed in low-dose group,middle-dose group and high-dose group,and the target effect-site concentrations of remifentanil all were 3.0 ng·mL^(-1),and the target effect-site concentrations of propofol were 3.0,4.0 and 5.0μg·mL^(-1),respectively.The examination began when the target effect-site concentrations of propofol and remifentanil both reached the target concentrations.The anesthesia effect,anesthesia quality(anesthesia time,patient comfort and operator anesthesia satisfaction),recovery time,intubation time and the safety was evaluated.Results The low-dose,middle-dose and high-dose groups included 31,36and 35 patients,respectively.The excellent and good rate of anesthesia in low-dose group,middle-dose group and high-dose group were 67.74%(21 cases/31 cases),77.78%(28 cases/36 cases)and 82.86%(29 cases/35 cases),respectively.The difference between middle-dose group and high-dose group and low-dose group was statistically significant(all P<0.05).In the low-dose group,the middle-dose group and the high-dose group,the satisfaction of anesthesia were(6.13±1.19),(7.48±1.25)and(6.50±1.07)min,respectively;the recovery time were(7.01±1.64),(7.58±1.30)and(9.42±1.58)min,respectively;the intubation time were(9.94±2.02),(10.76±1.97)and(13.18±2.25)min,respectively.There were statistically significant differences between low-dose group and middle-dose group and high-dose group(all P<0.05).The duration of anesthesia in low-dose group,middle-dose group and high-dose group were(31.18±4.26),(29.96±5.08)and(28.74±5.43)min,respectively;the comfort level were(8.95±0.49),(9.03±0.41)and(9.12±0.38)min,respectively;the incidence of hypotension was 12.90%,5.56%and 14.29%;the incidence of physical activity was16.13%,8.33%and 5.71%;the incidence of cough was 19.35%,13.89%and 11.43%,respectively,The satisfaction of anesthesiologists in the meddle-dose group was significantly higher than that in the low-dose group and the high-dose group,and the differences were statistically significant(all P<0.05).Conclusion Targetcontrolled infusion with propofol at a target effect-site concentration of 4.0μg·mL^(-1)and remifentanil at a target effect-site concentration of 3.0 ng·mL^(-1)has the optimal anesthesia quality,the shortest recovery time and intubation time and good safety in elderly patients with painless fiberoptic bronchoscopy.