环泊酚复合瑞芬太尼用于无痛纤维支气管镜检查的临床疗效分析

Clinical efficacy analysis of combination of ciprofol and remifentanil for painless fiberoptic bronchoscopy

摘要:

目的 探讨环泊酚与瑞芬太尼联合应用于无痛纤维支气管镜检查，对苏醒质量和炎症反应的影响。方法 选取2023年10月－2024年10月于该院行无痛纤维支气管镜检查的患者90例，随机分为环泊酚联合瑞芬太尼组（观察组）和丙泊酚联合瑞芬太尼组（对照组），各45例。采用脑电双频指数（BIS）监测麻醉深度。比较两组患者入室时（T₀）、置入喉罩即刻（T₁）、镜身进入气管隆突时（T₂）、检查结束时（T₃）和拔除喉罩后5 min（T₄）的血流动力学指标和BIS变化情况。比较两组患者纤维支气管镜检查时间、完成指令动作时间、纤维支气管镜检查前后恢复质量-40量表（QoR-40）评分、血清炎症因子水平和不良反应发生情况。结果 观察组T₄时点的血清肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）和白细胞介素-6（IL-6）表达水平明显低于对照组，差异均有统计学意义（P < 0.05）；两组患者T₀、T₁、T₂、T₃和T₄时点的BIS比较，差异均无统计学意义（P > 0.05），对照组T₁时点的平均动脉压（MAP）明显低于观察组，差异有统计学意义（P < 0.05）；两组患者纤维支气管镜检查时间和完成指令动作时间比较，差异均无统计学意义（P > 0.05）；两组患者T₀时点的QoR-40评分比较，差异均无统计学意义（P > 0.05）；T₄时点，观察组QoR-40评分中身体舒适度、情绪状态和总分明显高于对照组，差异均有统计学意义（P < 0.05）；两组均未发生严重不良反应，对照组低血压发生率为22.2%，明显高于观察组的4.4%，差异有统计学意义（P < 0.05），经补液和适当使用血管活性药物后得到缓解，观察组注射痛发生率明显低于对照组，差异有统计学意义（P < 0.05）。结论 环泊酚与瑞芬太尼联合应用于无痛纤维支气管镜检查是安全、有效的，且镇静和镇痛效果好，患者血流动力学稳定，无明显注射痛，能有效地降低炎症因子水平，提高早期苏醒质量和患者舒适度。值得应用于临床。

Abstract:

Objective To explore the effect of the combined application of ciprofol and remifentanil in painless fiberoptic bronchoscopy on the quality of recovery and inflammatory response.Methods 90 patients who underwent painless fiberoptic bronchoscopy from October 2023 to October 2024 were selected and randomly divided into the ciprofol combined with remifentanil group (observation group) and the propofol combined with remifentanil group (control group), with 45 cases in each group. The changes of hemodynamic indicators and BIS of the two groups of patients were compared at the time of entering the room (T₀), immediately after the laryngeal mask was placed (T₁), when the endoscope entered the tracheal protrusion (T₂), at the end of the examination (T₃), and 5 min after the laryngeal mask was removed (T₄). The scores of the quality of recovery-40 (QoR-40) before and after fiberoptic bronchoscopy, the levels of serum inflammatory factors, the time of fiberoptic bronchoscopy, the time to complete the instructed actions and the occurrence of adverse reactions were compared between the two groups of patients.Results The expression levels of serum tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and interleukin-6 (IL-6) at time point T₄ in the observation group were significantly lower than those in the control group, and the differences were statistically significant (P < 0.05). The comparison of BIS at T₀, T₁, T₂, T₃ and T₄ time points between the two groups of patients showed no statistically significant differences (P > 0.05). The mean arterial pressure (MAP) at T₁ time point in the control group was significantly lower than that in the observation group, and the difference was statistically significant (P < 0.05). There was no statistically significant difference in the comparison of fiberoptic bronchoscopy examination time and the time to complete the instructed actions between the two groups of patients (P > 0.05). There was no statistically significant difference in the QoR-40 score at T₀ time point between the two groups of patients (P > 0.05). At T₄ time point, the comfort level, emotional state and total score of QoR-40 in the observation group were significantly higher than those in the control group, and the differences were statistically significant (P < 0.05). No serious adverse reactions occurred in either group. The incidence of hypotension in the control group was 22.2%, significantly higher than 4.4% in the observation group, and the difference was statistically significant (P < 0.05). The symptoms were relieved after fluid replacement and appropriate use of vasoactive drugs. The incidence of injection pain in the observation group was significantly lower than that in the control group, and the difference was statistically significant (P < 0.05).Conclusion The combined application of ciprofol and remifentanil in painless fiberoptic bronchoscopy is safe and effective. It has good sedative and analgesic effects, stable hemodynamics in patients, no obvious injection pain, can effectively reduce the level of inflammation cytokines, improve the quality of early recovery and patient comfort. It is worth applying in clinical practice.