异丙酚联合舒芬太尼选择性麻醉在硬质胸腔镜检查中的临床应用价值及安全性研究

Clinical application value and safety of Propofol combined with Sufentanil selective anesthesia in rigid thoracoscope

摘要:

目的 探讨异丙酚联合舒芬太尼选择性麻醉下行硬质胸腔镜检查的价值和安全性。方法 选取2018年4月－2020年4月在甘肃中医药大学第三附属医院呼吸与危重症医学中心接受硬质胸腔镜检查的患者113例作为研究对象，按检查方法分组，两组患者均完成术前评估和准备。对照组51例，局麻下行硬质胸腔镜检查，观察组62例，在异丙酚联合舒芬太尼选择性静脉推注麻醉下进行硬质胸腔镜检查；观察两组患者经皮动脉血氧饱和度（SpO₂）、心率（HR）及收缩压（SBP）的变化、不良反应和再次硬质胸腔镜检查接受程度。结果 两组患者SpO₂术前、术中和术后比较，差异均无统计学意义（P > 0.05），观察组术中SpO₂最低值与术前、术后比较，差异均无统计学意义（P > 0.05）；两组患者术中HR及对照组术中HR与术前、术后比较，差异均有统计学意义（P < 0.01）；两组患者术中SBP及对照组术中SBP与术前、术后比较，差异均有统计学意义（P < 0.05）。两组患者均出现咳嗽，观察组36例（58.06%），对照组30例（58.82%），两组比较，差异无统计学意义（P > 0.05）；对照组45例（88.24%）感到憋气、50例（98.04%）感到疼痛，观察组患者清醒后询问无憋气和疼痛感，两组不良反应比较，差异有统计学意义（P < 0.01）；观察组62例患者中能接受再次硬质胸腔镜检查的有58例（93.55%），对照组51例患者中能接受再次硬质胸腔镜检查的仅有5例（9.80%），两组接受程度比较，差异有统计学意义（P < 0.01）。结论 异丙酚联合舒芬太尼选择性麻醉诱导下行硬质胸腔镜检查具有安全、无痛苦和容易接受等优点，同时体现了人性化服务的理念；只要在检查前对患者进行全面评估，并掌握适应证和禁忌证，且在具备完善的监护和抢救条件下，异丙酚联合舒芬太尼选择性麻醉诱导行硬质胸腔镜检查可应用于胸膜疾病的诊治。

Abstract:

Objective To explore the value and safety of rigid thoracoscope under selective anesthesia with Propofol and Sufentanil.Methods 113 patients who received rigid thoracoscope from April 2018 to April 2020 were selected as the research objects, and divided them into two groups according to the examination methods. Both groups of patients completed preoperative evaluation and preparation. 51 cases in the control group received rigid thoracoscope examination under local anesthesia, while 62 cases in the observation group received rigid thoracoscope examination under selective intravenous injection anesthesia of Propofol combined with Sufentanil. The changes of percutaneous arterial oxygen saturation (SpO₂), heart rate (HR), systolic blood pressure (SBP), adverse reactions and the acceptance of rigid thoracoscope were observed.Results There was no significant difference in SpO₂ of the two groups before, during and after operation, and intraoperative, preoperative and postoperative comparison of the two groups (P > 0.05). The intraoperative HR of the two groups and the intraoperative heart rate in control group were significant compared with those before and after operation (P < 0.01). The intraoperative SBP of the two groups and the intraoperative blood pressure in control group were statistically significant compared with those before and after operation (P < 0.05). Cough occurred in both groups, with 36 (58.06%) in observation group and 30 (58.82%) in control group. There was no significant difference between the two groups (P > 0.05). In control group, 45 (88.24%) felt breath-holding and 50 (98.04%) felt pain, while in observation group, patients were asked to feel no breath-holding and pain after waking up, and the difference between the two groups was statistically significant (P < 0.01). 58 patients (93.55%) in observation group and 5 patients (9.80%) in control group were able to receive medical thoracoscopy again. The acceptance degree between the two groups was statistically significant (P < 0.01).Conclusion Thoracoscopic examination induced by selective anesthesia with Sufentanil and Propofol is safe, painless and easy to accept, and embodies the concept of humanized service. It can be used in the diagnosis and treatment of pleural diseases as long as the patients are fully evaluated before rigid thoracoscope examination under the anesthesia induced by Sufentanil combined with Propofol, the indications and contraindications are well grasped, and the conditions of monitoring and rescue are perfect.