摘要
目的:观察依托咪酯联合丙泊酚用于老年患者无痛气管镜诊疗的疗效和安全性。方法:选择2019年10月-2020年5月于安徽省胸科医院内镜中心首次择期行全身麻醉下支气管镜诊疗的老年患者124例,按随机数字表法分为丙泊酚组(P组)和依托咪酯和丙泊酚组(EP组),每组62例。麻醉诱导时,两组患者均静脉缓慢推注枸橼酸舒芬太尼注射液5μg。在此基础上,P组患者静脉注射丙泊酚乳状注射液2 mg/kg至睫毛反射消失后,再静脉泵注丙泊酚乳状注射液4 mg/(kg·h)维持镇静+注射用盐酸瑞芬太尼0.1~0.2μg/(kg·min)维持镇痛;EP组患者静脉缓慢推注0.5%丙泊酚乳状注射液1 mg/kg+0.1%依托咪酯乳状注射液0.2 mg/kg至睫毛反射消失后,再静脉泵注0.5%丙泊酚乳状注射液+0.1%依托咪酯乳状注射液的混合乳剂(1∶1,V/V)20 mL/h维持镇静+注射用盐酸瑞芬太尼维持镇痛(用法用量同P组)。同时,两组患者静脉注射苯磺顺阿曲库铵0.1 mg/kg后,置入喉罩连接麻醉机进行机械通气后经喉罩置入气管镜进行诊疗。观察两组患者入室时(T1)、麻醉诱导后睫毛反射消失时(T2)、置入气管镜检查开始时(T3)、检查开始10 min时(T4)、麻醉苏醒时(T5)、出室时(T6)的平均动脉压(MAP)和心率(HR),手术时间、麻醉苏醒时间、血管活性药物使用情况,术后4 h认知功能以及不良反应发生情况。结果:两组各有2例患者被剔除。T1时,两组患者MAP、HR比较,差异均无统计学意义(P>0.05)。EP组患者各时间点MAP组间比较,差异均无统计学意义(P>0.05)。P组患者T2时的MAP、HR和T4时的MAP,EP组患者T2时的HR均显著低于同组T1时,且P组T2、T4时的MAP均显著短于或低于EP组同期(P<0.05)。EP组患者麻醉苏醒时间、低血压发生率、血管活性药物使用率均显著低于P组;术后4 h,EP组患者记忆能力、计算能力、定向能力通过率均显著高于P组(P<0.05);而两组患者手术时间、注射疼痛、肌阵挛、恶心呕吐发生率以及专注能力、语言能力、结构能力、推理能力通过率比较,差异均无统计学意义(P>0.05)。结论:依托咪酯联合丙泊酚用于老年患者无痛气管镜的疗效和安全性均较好。
OBJECTIVE:To observe the efficacy and safety of the application of etomidate combined with propofol in diagnosis and treatment of elderly patients with painless tracheoscope.METHODS:A total of 124 elderly patients with first selective bronchoscopy under general anesthesia were collected from Anhui Chest Hospital during Oct.2019-May 2020,and then divided into propofol group(group P),etomidate and propofol group(group EP)according to random number table,with 62 cases in each group.At anesthesia induction,Sufentanil citrate injection 5μg was slowly injected into both groups.Based on this base,group P was given Propofol injectable emulsion 2 mg/kg intravenously;after the eyelash reflex disappeared,group P was given intravenous infusion of Propofol injectable emulsion 4 mg/(kg·h)to maintain sedation and Remifentanil hydrochloride for injection 0.1-0.2μg/(kg·min)to maintain analgesia.Group EP was given slow intravenous injection of 0.5%Propofol injectable emulsion 1 mg/kg+0.1%Etomidate injectable emulsion 0.2 mg/kg;after the eyelash reflex disappeared,group EP was given intravenous pump of 0.5%Propofol injectable emulsion+0.1%Etomidate injectable emulision mixture(1∶1,V/V)20 mL/h to maintain sedation and Remifentanil hydrochloride for injection to maintain analgesia(same usage and dosage as group P);at the same time,2 groups were given intravenous injection of Cisatracurium besilate for injection 0.1 mg/kg,the laryngeal mask was inserted into the anesthesia machine for mechanical ventilation,and then the laryngeal mask was placed into the tracheoscope for diagnosis and treatment.Heart rate(HR)and mean arterial pressure(MAP)were observed in 2 groups at the time of entering the room(T1),at the time of eyelash reflex disappearing after anesthesia induction(T2),at the beginning of tracheal intubation examination(T3),10 min after the beginning of the examination(T4),at the time of anesthesia recovery(T5),and at the time of leaving the room(T6);operation time,anesthesia recovery time,the use of vasoactive drugs,postoperative 4 h cognitive function and adverse reactions were also observed in 2 groups.RESULTS:Two patients in each group were excluded.At T1,there was no statistical significance in MAP and HR between 2 groups(P>0.05).There was no statistical significance in MAP of group EP among different time points(P>0.05).MAP and HR of group P at T2,MAP of group P at T4,HR of group EP at T2 were significantly lower than same group at T1,and MAP of group P at T2 and T4 were significantly shorter or lower than those of group EP at the same time(P<0.05).The anesthesia recovery time,the incidence of hypotension and the utilization rate of vasoactive drugs in group EP were significantly lower than group P;memory ability,calculation ability and orientation force pass rate of group EP were significantly higher than those of group P of 4 h after operation(P<0.05).There was no statistical significance in operation time,the incidence of injection pain,muscle spasm,nausea and vomiting,focus ability,language ability,structure ability,reasoning ability pass rate between 2 groups(P>0.05).CONCLUSIONS:Etomidate combined with propofol shows good therapeutic efficacy and safety for elderly patients with painless tracheoscope.
作者
姚晶曼
李元海
YAO Jingman;LI Yuanhai(Dept.of Anesthesiology,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Dept.of Anesthesiology,Anhui Chest Hospital,Hefei 230032,China)
出处
《中国药房》
CAS
北大核心
2020年第24期3031-3035,共5页
China Pharmacy
基金
安徽省重点研究与开发计划项目(No.1704f0804021)。
关键词
丙泊酚
依托咪酯
老年患者
气管镜
疗效
安全性
Propofol
Etomidate
Elderly patients
Tracheoscope
Therapeutic efficacy
Safety
