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| 环泊酚或丙泊酚复合瑞芬太尼用于无痛纤维支气管镜检查的比较 |
| Comparison of ciprofol or propofol combined with remifentanil for painless fiberoptic bronchoscopy |
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| DOI：10.12089/jca.2023.10.008 |
| 中文关键词: 环泊酚 丙泊酚 无痛纤维支气管镜检查 梦境 |
| 英文关键词: Ciprofol Propofol Painless fiberoptic bronchoscopy Dream |
| 基金项目:中国初级卫生保健基金会项目（YLGX-WS-2020001） |
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| 中文摘要: |
目的 探讨环泊酚或丙泊酚复合瑞芬太尼用于无痛纤维支气管镜检查的麻醉效果及对梦境状态的影响。
方法 选择择期行全麻下无痛纤维支气管镜检查的患者60例，男27例，女33例，年龄18～75岁，BMI 20～30 kg/m2，ASA Ⅰ或Ⅱ级。将患者随机分为两组：丙泊酚组（P组）和环泊酚组（C组），每组30例。麻醉诱导：P组静注丙泊酚2.5 mg/kg和瑞芬太尼1 μg/kg；C组静注环泊酚0.4 mg/kg和瑞芬太尼1 μg/kg。麻醉维持：P组泵注丙泊酚4～6 mg·kg-1·h-1；C组泵注环泊酚0.8～1.2 mg·kg-1·h-1。记录低血压的发生情况、麻黄碱用量，麻醉诱导前5 min（T0）、插入喉罩即刻（T1）、纤维支气管镜进至隆突时（T2）、镜检完毕（T3）及拔除喉罩时（T4）的HR、MAP和SpO2。记录呛咳评分、利多卡因用量、手术时间、苏醒时间、定向力恢复时间、梦境的发生情况和状态、静脉注射痛、心动过缓、呼吸暂停、呛咳及恶心呕吐等相关不良事件的发生情况。
结果 与T0时比较，T1时两组MAP均明显降低（P<0.05）。与P组比较，C组低血压的发生率明显降低（P<0.05），麻黄碱用量明显减少(P<0.05)，T1和T3时MAP明显升高(P<0.05)，梦境的情绪评分明显升高(P<0.05)，静脉注射痛及呼吸暂停相关不良事件的发生率明显降低(P<0.05)。两组呛咳评分、利多卡因用量、手术时间、苏醒时间、定向力恢复时间、梦境发生率、心动过缓、呛咳及恶心呕吐相关不良事件的发生率差异无统计学意义。
结论 与丙泊酚比较，环泊酚复合瑞芬太尼在无痛纤维支气管镜检查中对循环呼吸影响小，不良事件发生率更低，同时可产生更优情绪的梦境状态。 |
| 英文摘要: |
Objective To investigate the anesthetic effects of ciprofol or propofol combined with remifentanil in painless fiberoptic bronchoscopy, and their impact on the dream state.
Methods Sixty patients, 27 males and 33 females, aged 18-75 years, BMI 20-30 kg/m2, ASA physical status Ⅰ or Ⅱ underwent elective painless fiberoptic bronchoscopy under general anesthesia. The group was randomly divided into the propofol group (group P) and the ciprofol group (group C), 30 patients in each group. For anesthesia induction, propofol 2.5 mg/kg and remifentanil 1 μg/kg were administered by static injection in group P, while ciprofol 0.4 mg/kg and remifentanil 1 μg/kg were similarly injected in group C. For anesthesia maintenance, propofol 4-6 mg·kg-1·h-1 was administered by pump in group P, while ciprofol 0.8-1.2 mg·kg-1·h-1 was pumped in group C. The incidence of hypotension and ephedrine dosage were recorded in both groups. The heart rate (HR), mean arterial pressure (MAP), and pulse oximetry (SpO2) were documented 5 minutes before anesthetic introduction (T0), as well as immediately after laryngeal mask insertion (T1),the time when the fiberoptic bronchoscope entered the carina (T2), at the end of bronchoscopy (T3), and at the time when the laryngeal mask was removed (T4). The coughing scores, lidocaine dosage, durations of the operation, awakening time, and directional force recovery time were recorded. The incidence of dreams, state of dreams and adverse events related to intravenous pain, bradycardia, apnea, cough, nausea and vomiting were recorded.
Results Compared with T0, MAP of both groups decreased significantly at T1 (P < 0.05). Compared with group P, the incidence of hypotension and ephedrine dosage in group C were significantly reduced (P < 0.05), MAP was significantly increased at T1 and T3 (P < 0.05), the dream emotion score of group C was significantly higher (P < 0.05), the incidence of intravenous pain and apnea related adverse events was significantly reduced (P < 0.05). There were no significant differences between the two groups in coughing scores, lidocaine dosage, durations of the operation, awakeing time, directional force recovery time, incidence of dreams, bradycardia and cough.
Conclusion Compared with propofol, the use of the ciprofol combined with remifentanil in painless fiberoptic bronchoscopy had less impact on circulation and respiration, together with a lower incidence of adverse events and the production of favorable emotional dream states. |
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