芬太尼联合咪达唑仑在支气管镜检查中的安全性和有效性分析

摘要

目的 探讨芬太尼联合咪达唑仑在支气管镜检查中的安全性和有效性.方法 选择北京宣武医院2015年1月至2016年12月收治的符合支气管镜检查的132例患者,男69例,女63例,年龄26 ～ 82岁,平均(63±10)岁,分为两组:(1)观察组:66例,男37例,女29例,年龄26～82岁,平均(63±10)岁,在局部麻醉的基础上加用芬太尼联合咪达唑仑静脉麻醉;(2)对照组:66例,男36例,女30例,年龄30 ～ 82岁,平均(63 ± 10)岁,应用2％利多卡因局部麻醉.记录麻醉前以及达到麻醉深度后5 min时患者的心率、平均动脉压及脉搏氧饱和度,并记录支气管镜检查过程中上述指标的波动情况和不良反应.本研究为前瞻性单中心随机对照研究.采用SPSS 19.0统计软件分析数据.统计方法采用t检验和x2检验.结果 观察组支气管镜检查过程中各项指标的波动值:心率为(12.3±2.3)次/min,平均动脉压为(5.9±2.2)mmHg(1 mmHg =0.133 kPa),脉搏氧饱和度为(4.4±1.3)％;对照组的心率为(21.9±1.8)次/min,平均动脉压为(7.1±2.3) mmHg,脉搏氧饱和度为(13.3±4.2)％,各项指标观察组均低于对照组,差异有统计学意义(t值为74.41、7.84和30.48,均P＜0.001).观察组麻醉5 min后的心率为(80.0±11.9)次/min,平均动脉压为(95.0±9.7) mmHg,脉搏氧饱和度为(90.0±5.7)％;对照组麻醉5 min后的心率为(90.3±17.0)次/min,平均动脉压为(102.7±12.4) mmHg,脉搏氧饱和度为(96.5±3.0)％,观察组低于对照组,差异有统计学意义(F值分别为7.122、6.988和58.61,均P＜0.001).支气管镜检查过程发生恶心、剧咳、屏气例数观察组(6例)少于对照组(27例),检查后对检查过程观察组遗忘例数(52例)优于对照组(0例),且满意度(58例)好于对照组(25例).结论 支气管镜检查过程中,芬太尼联合咪达唑仑麻醉时患者生命体征波动范围小、耐受性好,但麻醉早期对患者的生命体征有一定影响,对适应证的选择要求更加严格.%Objective To study the effectiveness and safety in bronchoscopy under anesthesia with fentanyl combined with midazolam.Methods We randomly allocated 132 patients(male 69,female 63,median age 62.9 years) requiring bronchoscopy in Beijing Xuanwu Hospital into 2 groups during January 2015 to December 2016.The trial group included 66 patients,receiving fentanyl combined with midazolam for anesthesia,while the control group of 66 patients receiving 2％ lidocaine for topical anesthesia.In the trial group,there were 37 males and 29 females,with a median age of 63 years (range 26-82).In the control group,there were 36 males and 30 females,with a median age of 62.8 years (range 30-82).The pulse,mean arterial pressure,and the oxygen saturation of the patients were recorded before anesthesia and 5 minutes after deep anesthcsia was reached.Changes of vital signs and adverse reactions during the bronchoscopy were also observed.Results The fluctuation of pulse (12.3 ± 2.3)/min,mean arterial pressure(5.9 ±2.2) mmHg(1 mmHg =0.133 kPa) and oxygen saturation(4.4 ± 1.3) ％ was lower in the trial group as compared to that of the control group,pulse(21.9 ± 1.8)/min,mean arterial pressure(7.1 ± 2.3) mmHg,oxygen saturation (13.3 ± 4.2) ％,P ＜ 0.001.Five minutes after anesthesia,the pulse (80.0 ± 11.9)/min,the mean arterial pressure (95.0 ± 9.7) mmHg and the oxygen saturation (90.0 ± 5.67) ％ of patients in the trial group were lower than those in the control group [pulse(90.3 ± 17.0)/min,mean arterial pressure (102.7 ± 12.4) mmHg,oxygen saturation (96.5 ± 3.0) ％],the differences being statistically significant(P ＜ 0.001).The trial group also showed smaller fluctuation,better tolerance,and fewer adverse reaction sthan the control group.Conciusion Fentanyl combined with midazolam is safe and effective in bronchoscopy with fewer adverse reactions,but its early effect on the vital signs should be monitored and stricter indications may be needed.