丙泊酚复合3种使用剂量瑞芬太尼靶控输注在经喉罩纤维支气管镜介入术中的麻醉质量分析

Effect of propofol with three doses of remifentanil on the quality of anesthesia for transglottic fiberoptic bronchoscopic intervention

摘要:

目的 分析丙泊酚复合3种使用剂量瑞芬太尼靶控输注在经喉罩纤维支气管镜介入术中的麻醉质量。方法 选取2019年2月－2021年12月该院择期行纤维支气管镜介入治疗的患者96例，采用随机数表法分为A组、B组和C组，各32例。3组均行喉罩全身麻醉，A组、B组和C组瑞芬太尼剂量分别为0.2 μg/（kg·min）（低剂量）、0.3 μg/（kg·min）（中剂量）和0.4 μg/（kg·min）（高剂量）。比较3组患者手术时间、麻醉质量（麻醉时间和手术医生麻醉满意度）、不同时间点心率（HR）、平均动脉压（MAP）、氧化应激因子［过氧化氢酶（CAT）、丙二醛（MDA）、超氧化物歧化酶（SOD）］水平、麻醉苏醒质量（苏醒时间、听指令睁眼时间和滞留苏醒室时间）、苏醒后不同时间点舒适度评分（BCS）和不良反应发生情况。结果 B组和C组手术医生麻醉满意度评分均高于A组（P < 0.05）；B组和C组T₂、T₃时点HR和MAP均低于A组（P < 0.05）；B组和C组手术开始10 min血清CAT和SOD水平均高于A组，血清MDA水平均低于A组（P < 0.05）；3组患者苏醒时间、听指令睁眼时间和滞留苏醒室时间比较，差异均无统计学意义（P > 0.05）；B组和C组苏醒后10 min和1 h BCS均高于A组（P < 0.05）；B组不良反应发生率为0.00%，低于A组的18.75%和C组的18.75%，差异均有统计学意义（P < 0.05）。结论 经喉罩纤维支气管镜介入术全身麻醉中应用中剂量瑞芬太尼复合丙泊酚，能获得满意的麻醉质量，不良反应少，安全性高。

关键词:纤维支气管镜介入术;全身麻醉;瑞芬太尼;丙泊酚;剂量;麻醉质量

Abstract:

Objective To investigate the effect of propofol compounded with remifentanil in three doses of target-controlled infusion on the quality of anesthesia in general anesthesia for transglottic fiberoptic bronchoscopic intervention.Methods 96 patients underwent fiberoptic bronchoscopic intervention from February 2019 to December 2021 were selected and divided into group A, B, and C using the random number table method, with 32 cases in each group. Laryngeal mask general anesthesia was performed in the three groups, and the doses of remifentanil in group A, B, and C were 0.2 μg/(kg·min) (low dose), 0.3 μg/(kg·min) (medium dose), and 0.4 μg/(kg·min) (high dose). We compared the duration of surgery, quality of anesthesia (duration of anesthesia, surgeon's satisfaction with anesthesia), heart rate (HR), mean arterial pressure (MAP), oxidative stress indicators [catalase (CAT), malondialdehyde (MDA), superoxide dismutase (SOD)] levels, quality of anesthesia awakening (time to awaken, time to open eyes on command, time to stay in the awakening room), post-awakening in the three groups, Bruggrmann comfort score (BCS) at different time points, and the occurrence of adverse reactions.Results The surgeons’ satisfaction scores of anesthesia were higher in group B and C than that in group A (P < 0.05); HR and MAP at T₂ and T₃ time points were lower in group B and C than that in group A (P < 0.05); Serum CAT and SOD levels were higher in group B and C than those in group A at 10 min after the start of surgery, and serum MDA level was lower than that in group A (P < 0.05); There were no significant differences in the recovery time, eye opening time after listening to instructions and the time in the recovery room among the three groups (P > 0.05); The BCS at 10 min and 1 h after awakening were higher in group B and C than that in group A (P < 0.05); The incidence of adverse reactions was lower in group B (0.00%) than that in group A (18.75%) and group C (18.75%) (P < 0.05).Conclusion The use of medium-dose remifentanil with propofol in general anesthesia for translaryngeal mask fiberoptic bronchoscopic intervention can obtain satisfactory quality of anesthesia with few adverse effects and high safety.

Key words:fiberoptic bronchoscopic intervention;general anesthesia;remifentanil;propofol;dose;quality of anesthesia