右美托咪定在心脏术后肺部感染患者纤维支气管镜检查中的麻醉效果

发布时间：2019-05-07 00:23

【摘要】：目的探讨心脏术后肺部感染的清醒患者行纤维支气管镜检查(纤支镜检查)时使用右美托咪定的麻醉效果。方法 98例确诊肺部感染需行纤支镜检查的心脏术后清醒患者随机分为两组。右美托咪定组50例,以右美托咪定0.5μg·kg-1为首剂量,0.5~1.0μg·kg-1·h-1为维持剂量;丙泊酚组48例,以丙泊酚1~1.5 mg·kg-1为首剂量,2~4 mg·kg-1·h-1为维持剂量实施静脉麻醉。比较两组患者给药前(T0)、检查开始时(T1)、检查开始后5 min(T2)、检查结束时(T3)平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(Sp O2)、呼吸频率(RR)和心率收缩压乘积(HPP)的变化,同时记录各时点ST段及T波变化,观察患者不良反应发生情况。结果两组患者基线资料无显著差异(P0.05)。丙泊酚组T2、T3时MAP和HR均高于T0时,T2、T3、T4时HPP均高于T0时(P0.05);T3时丙泊酚组MAP、HR、HPP水平均高于右美托咪定组(P0.05)。T1时右美托咪定组心电图ST段阳性变化发生率为25%,高于丙泊酚组(4%,P0.05)。右美托咪定组发生呛咳14例、体动12例、喉痉挛4例,丙泊酚组分别为26例、23例、10例,右美托咪定组呛咳、体动、喉痉挛的发生率低于丙泊酚组(P0.05)。结论对于心脏术后肺部感染的清醒患者,与丙泊酚相比,以右美托咪定镇静实施纤支镜检查,患者血流动力学更平稳,麻醉效果提高。
[Abstract]:Objective to investigate the anesthetic effect of right metomidine in conscious patients with pulmonary infection after cardiac surgery by fiberoptic bronchoscopy (fiberbronchoscopy). Methods 98 patients with pulmonary infection who underwent fiberoptic bronchoscopy were randomly divided into two groups. 50 patients in right metometomidine group were treated with first dose of right metometridamidine 0.5 渭 g kg-1 and 0.5 ~ 1.0 渭 g kg- 1 路h-1 as maintenance dose. 48 patients in propofol group were given intravenous anesthesia at the first dose of propofol 1 / 1.5 mg kg-1 and 2 / 4 mg kg- 1 路h ~ (- 1) at the maintenance dose of 2 ~ 4 min 路h ~ (- 1). Before administration (T0), at the beginning of the examination (T1), 5 min (T2) after the examination, and at the end of the examination (T 3), the mean arterial pressure (MAP), heart rate, (HR), pulse oxygen saturation (Sp O 2), and blood oxygen saturation (Sp O 2) were compared between the two groups. The changes of respiratory rate (RR) and systolic blood pressure product (HPP) of heart rate were observed. The changes of ST segment and T wave at each time point were recorded at the same time to observe the occurrence of adverse reactions in the patients. Results there was no significant difference in baseline data between the two groups (P0.05). In propofol group, the levels of MAP and HR at T _ 2, T _ 3 and T _ 0 were higher than those at T _ 0, T _ 2, T _ 3, T _ 4 and T _ 0 (P0.05). The level of MAP,HR,HPP in propofol group was higher than that in right metametridamidine group at T3 (P0.05), and the incidence of positive changes of ST segment in right metametomidine group was 25% at T1, which was higher than that in propofol group (4%, P0.05). There were 14 cases of choking, 12 cases of body movement, 4 cases of laryngospasm in the right metometomidine group, and 26 cases in the propofol group, 23 cases in the propofol group, 10 cases in the propofol group, and the incidence of choking, movement and laryngospasm in the right metomidine group was lower than that in the propofol group (P0.05). Conclusion compared with propofol, the haemodynamics of the patients with pulmonary infection after cardiac surgery is more stable and the anesthetic effect is improved by using right metomidine sedation and fiberbronchoscopy. [WT5 "HZ] conclusion [WT5" BZ] [WT5 "BZ]
【作者单位】：四川省医学科学院·四川省人民医院重症医学科;
【基金】：四川省卫生厅课题(110143)
【分类号】：R614

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