环泊酚联合阿芬太尼用于支气管镜检查术患者的临床研究

Clinical trial of cipofol combined with afentanil in the treatment of patients undergoing bronchoscopy

目的比较环泊酚注射液与丙泊酚注射液分别联合阿芬太尼注射液用于喉罩通气全身麻醉下行气管镜检查术患者的临床疗效及安全性。方法将拟行气管镜检查患者随机分为试验组和对照组。试验组静脉推注20μg·kg^(-1)阿芬太尼、0.4 mg·kg^(-1)环泊酚和0.2 mg·kg^(-1)顺式阿曲库铵进行麻醉诱导;对照组静脉推注20μg·kg^(-1)阿芬太尼、2 mg·kg^(-1)丙泊酚和0.2 mg·kg^(-1)顺势式阿曲库铵进行麻醉诱导。2组患者均用喉罩通气全身麻醉。试验组静脉给予0.8 mg·kg^(-1)·h^(-1)环泊酚和0.5~1.0μg·kg^(-1)·min^(-1)阿芬太尼进行麻醉维持;对照组静脉给予8 mg·kg^(-1)·h^(-1)丙泊酚和0.5~1.0μg·kg^(-1)·min^(-1)阿芬太尼进行麻醉维持。比较2组患者麻醉过程中的生命体征、麻醉诱导和恢复时间、阿芬太尼用量,以及安全性。结果试验组入组70例,脱落10例,最终有60例纳入统计分析;对照组入组70例,脱落10例,最终有60例纳入统计分析。在诱导3 min后(T1),试验组和对照组的平均动脉压(MAP)分别为(79.32±5.73)和(73.15±6.20)mmHg,心率(HR)分别为(70.53±8.20)和(65.77±7.75)beat·min^(-1);在置入支气管镜时(T2),试验组和对照组的MAP分别为(82.52±5.81)和(75.99±6.09)mmHg,HR分别为(70.27±7.94)和(65.42±7.73)beat·min^(-1);试验组在T1、T2时的MAP和HR均显著高于同时刻的对照组,在统计学上差异均有统计学意义(均P<0.05)。试验组和对照组的麻醉诱导时间分别为(76.23±6.51)和(66.93±6.26)s,在统计学上差异有统计学意义(P<0.05);试验组和对照组的麻醉苏醒期睁眼时间分别为(8.42±1.94)和(8.48±2.13)min,术中阿芬太尼用量分别为(3456.67±608.51)和(3515.00±619.41)μg,在统计学上差异均无统计学意义(均P>0.05)。试验组和对照组在诱导期注射痛发生率分别为3.33%和30.00%,术中低血压发生率分别为18.33%和40.00%,术中心动过缓发生率分别为3.33%和13.33%,在统计学上差异均有统计学意义(均P<0.05)。结论相比于丙泊酚注射液联合阿芬太尼注射液,环泊酚注射液联合阿芬太尼注射液用于喉罩通气全身麻醉下行气管镜检查术患者在麻醉诱导和维持期能够更好地维持血流动力学稳定,且安全性较好。

Objective To compare the clinical efficacy and safety of cyclopofol injection and propofol injection combined with afentanil injection in patients undergoing tracheoscopy under laryngeal mask ventilation under general anesthesia.Methods The patients to undergo tracheoscopy were randomly divided into treatment group and control group.Induction of anesthesia:treatment group received 20 μg · kg^(-1) afentanil,0.4 mg · kg^(-1) ciprofol and 0.2 mg · kg^(-1) cisatracurium;control group received20 μg·kg^(-1) afentanil,2 mg·kg^(-1) propofol and 0.2 mg·kg^(-1) cisatracurium.Two groups were given laryngeal mask ventilation for general anesthesia.The treatment group received 0.8 mg·kg^(-1)·h^(-1)cypofol and 0.5-1.0 μg·kg^(-1)·min^(-1) afentanil to perform the anesthesia maintenance;the control group was received 8 mg·kg^(-1)·h^(-1)propofol and0.5-1.0 μg·kg^(-1)·min^(-1) afentanil to perform the anesthesia maintenance.The vital signs,induction and recovery time,dosage of afentanil during anesthesia and safety were compared between the two groups.Results Treatment group were enrolled 70 cases,10 cases dropped out,and 60 cases were finally included in the statistical analysis.Control group were enrolled 70 cases,10 cases dropped out,and ultimately 60 cases were finally included in the statistical analysis.Three minutes after induction of anesthesia(T1),the mean arterial pressure(MAP) of treatment group and control group were(79.32±5.73) and(73.15±6.20) mmHg,the heart rate(HR) were(70.53±8.20) and(65.77±7.75) beat·min^(-1),respectively.At insert the bronchoscope(T2),MAP of treatment group and control group were(82.52±5.81) and(75.99±6.09) mmHg,HR were(70.27±7.94) and(65.42±7.73) beat·min^(-1),respectively.The MAP and HR of treatment group at T1 and T2 were significantly higher than those of control group at the same time,the differences were statistically significant(all P <0.05).The induction time of treatment group and control group was(76.23±6.51) and(66.93±6.26) s,and the difference was statistically significant(P <0.05).The eye opening time during anesthesia recovery of treatment group and control group was(8.42±1.94) and(8.48±2.13) min,the intraoperative dosage of fentanyl was(3 456.67±608.51) and(3 515.00±619.41) μg,respectively,the differences of above indexes in two groups were not statistical significance(all P> 0.05).The incidences of injection pain during induction period in treatment group and control group were 3.33% and 30.00%,the incidences of hypotension in treatment group and control group were 18.33% and 40.00%,the incidences of intraoperative bradycardia in treatment group and control group were 3.33% and 13.33%,respectively,the differences were statistically significant(all P <0.05).Conclusion Compared with propofol injection combined with afentanil injection,cipofol injection combined with afentanil injection can better maintain hemodynamic stability during anesthesia induction and maintenance in patients undergoing tracheoscopy under general anesthesia with laryngeal mask ventilation,and has better safety.