摘要
目的比较环泊酚与丙泊酚用于老年患者保留自主呼吸全身麻醉下行支气管镜检查术的麻醉效果。方法选择2023年1~12月择期行支气管镜检查的老年患者160例,采用随机数字表法随机分为环泊酚组和丙泊酚组,每组80例,2组各有5例剔除,最终每组75例。环泊酚组麻醉诱导:阿芬太尼10μg/kg、环泊酚0.4 mg/kg,麻醉维持:环泊酚1~1.5 mg·kg^(-1)·h^(-1)、阿芬太尼0.5μg·kg^(-1)·min^(-1)。丙泊酚组麻醉诱导:阿芬太尼10μg/kg、丙泊酚2 mg/kg,麻醉维持:丙泊酚4~6 mg·kg^(-1)·h^(-1)、阿芬太尼0.5μg·kg^(-1)·min^(-1)。比较2组镇静成功率,诱导时间,苏醒时间,麻醉诱导前(T0)、气管镜通过声门时(T1)、诊疗开始10 min后(T2)、患者苏醒时(T3)平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、呼吸频率(respiratory rate,RR)和脑电双频指数(bispectral index,BIS),以及心动过缓、低血压、低氧血症、注射痛、诊疗过程中追加镇静药物、阿片药物和术后恶心呕吐的发生情况。结果2组患者镇静成功率、诱导时间和苏醒时间差异均无统计学意义(P>0.05)。与T0比较,MAP、HR、RR和BIS在T1、T2显著降低(均P=0.000),T3恢复到T0水平(P=0.470,0.307,0.662);2组间比较RR差异有统计学意义(P=0.047),组别×时间交互作用显著(P=0.000),MAP、HR和BIS差异无显著性(P>0.05),组别×时间交互作用不显著(P>0.05)。与丙泊酚组相比,环泊酚组低血压、低氧血症和注射痛发生率明显降低(P<0.05),2组心动过缓、术中追加镇静药物、追加阿芬太尼和术后恶心呕吐发生率差异无统计学意义(P>0.05)。结论与丙泊酚比较,环泊酚联合阿芬太尼在老年患者保留自主呼吸下行纤维支气管镜检查中对呼吸影响较小,低血压、低氧血症和注射痛发生率较低,同时可提供良好的麻醉镇静效果,值得推广应用。
Objective To compare the anesthetic effects of cyclopofol and propofol for bronchoscopy under general anesthesia with reserved spontaneous respiration in elderly patients.Methods A total of 160 elderly patients scheduled for bronchoscopy from January to December 2023 were selected.By using the random number table method,the patients were divided into the cyclopofol group and the propofol group,with 80 cases in each group.Because 5 cases were excluded from each of the two groups,finally there were 75 cases in each group.In the cyclopofol group,the afentanil 10μg/kg and cyclopofol 0.4 mg/kg was used for anesthesia induction,and the cyclopofol 1-1.5 mg·kg^(-1)·h^(-1)and afentanil 0.5μg·kg^(-1)·min^(-1)was used for anesthesia maintenance.In the propofol group,the afentanil 10μg/kg and propofol 2 mg/kg was used for anesthesia induction,and the propofol 4-6 mg·kg^(-1)·h^(-1)and afentanil 0.5μg·kg^(-1)·min^(-1)was used for anesthesia maintenance.The success rate of sedation,induction time,and recovery time were compared between the two groups.The mean arterial pressure(MAP),heart rate(HR),respiratory rate(RR),and bispectral index(BIS)before anesthesia induction(T0),when bronchoscopy passes through the glottis(T1),at 10 min after the start of diagnosis and treatment(T2),and when the patient was awake(T3)were compared between the two groups.The incidence of bradycardia,hypotension,hypoxemia,injection pain,additional sedatives and opioids during diagnosis and treatment,and postoperative nausea and vomiting were compared between the two groups.Results There were no statistically significant differences in the success rate of sedation,induction time,and recovery time between the two groups(P>0.05).Compared with T0,the MAP,HR,and RR significantly decreased at T1 and T2(all P=0.000),and returned to the levels of T0 at T3(P=0.470,0.307,and 0.662).Between the two groups,there was a statistically significant difference in RR(P=0.047),the interaction between groups×time was significant(P=0.000),and there was no significant difference in MAP,HR and BIS(P>0.05).Compared with the propofol group,the incidences of hypotension,hypoxemia,and injection pain in the cyclopofol group were significantly lower(P<0.05).There were no statistically significant differences in the incidences of bradycardia,intraoperative sedative drug addition,afentanil addition and postoperative nausea and vomiting between the two groups(P>0.05).Conclusions Compared with propofol,cyclopofol combined with alfentanil has less impact on respiration in fiberoptic bronchoscopy in elderly patients with spontaneous respiration,and the incidences of hypotension,hypoxemia,and injection pain are lower.It can provide good anesthetic and sedative effects and is worthy of promotion and application.
作者
回宇峰
谭思琪
刁玉刚
李林
Hui Yufeng;Tan Siqi;Diao Yugang(Department of Anesthesiology,Chinese People’s Liberation Army Northern Theater Command General Hospital,Shenyang 110016,China)
出处
《中国微创外科杂志》
北大核心
2026年第1期9-15,共7页
Chinese Journal of Minimally Invasive Surgery
