丙泊酚TCI不同起始靶浓度在老年患者纤维支气管镜检查中的安全性和有效性比较

发布时间：2018-03-20 17:45

本文选题：纤维支气管镜　切入点：丙泊酚　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景及目的纤维支气管镜检查(Fiberoptic bronchoscopy,FB)是目前呼吸系统疾病的确诊和某些肺部疾患治疗的首选方法,但其对咽喉及气管有强烈的刺激。丙泊酚靶控输注(target controlled infusion,TCI)操作简便,可控性好,血药浓度稳定,能为行纤维支气管镜检查的患者提供较好的舒适性和快速苏醒,目前已广泛应用。根据临床经验以及国内外研究显示丙泊酚TCI的起始血浆靶浓度为2.0μg/ml。随着社会老龄化以及肺癌在高龄人群的增加,老年人成为纤支镜检查的主要人群。老年患者心肺代偿功能差,常合并其他疾病,行纤维支气管镜检查术时容易引起循环系统剧烈波动,诱发心血管不良反应。而丙泊酚TCI用于纤支镜检的老年患者的适宜的起始血浆靶浓度目前尚不清楚。本研究对比了丙泊酚TCI的两种不同起始血浆靶浓度在老年纤维支气管镜检的安全性及有效性,拟探讨老年患者行纤支镜检时丙泊酚TCI适宜的起始血浆靶浓度。方法本研究采取随机设计。选择行纤维支气管镜检查的患者64例,入室前采用数字表法随机分成两组,丙泊酚起始血浆靶浓度1.0μg/ml(A组)和丙泊酚起始血浆靶浓度2.0μg/ml(B组)。患者入室后开放静脉通路,采取鼻导管吸氧4-6 L/min,利多卡因行鼻腔、口腔、咽喉部及声门下充分表面麻醉。随后进行靶控输注,瑞芬太尼效应室靶浓度0.8ng/ml靶控输注,丙泊酚血浆靶浓度1.0μg/ml或2.0μg/ml靶控输注,当效应室浓度达到设定的目标血浆靶浓度时开始进行检查,并记录此时的镇静水平,检查结束时即停止给药。记录患者生命体征的变化、麻醉诱导时间(从麻醉诱导到检查开始的时间)、检查持续时间以及苏醒时间、利多卡因、血管活性药及丙泊酚用量,比较两组不良反应(低氧血症以及低血压)发生率、患者及术者操作满意度情况。结果低氧血症的发生率,A组明显低于B组,P0.05;对低氧血症实行的临床干预措施中,A组放置口咽通气道的次数明显少于B组,P0.05。术中出现低血压的次数A组低于B组,P0.05。术中血管活性药的使用方面,A组去氧肾上腺素的使用量明显低于B组,P0.05。A组的MOAA/S评分高于B组,P0.05,有统计学差异。B组患者的丙泊酚术中维持靶浓度为1.6±0.2μg/ml,较A组(1.1±0.3μg/ml)有明显升高,P0.05,差异有统计学意义。B组麻醉诱导时间、苏醒时间明显长于A组,P0.05,有统计学差异。但B组的术者满意度评分稍高于A组,P=0.046。结论在老年人行纤维支气管镜检查时,低剂量1μg/ml的丙泊酚起始靶浓度既能满足镇静的需求,而且用药量更少,术中不良反应更少,麻醉管理更安全。
[Abstract]:Background and objective Fiberoptic bronchoscopy FB (Fiberoptic bronchoscopy FB) is the first choice for the diagnosis of respiratory system diseases and the treatment of some pulmonary diseases, but it has strong stimulation to throat and trachea. Target controlled infusion of propofol is simple and controllable. Stable blood concentration can provide better comfort and rapid recovery for patients undergoing fiberoptic bronchoscopy. The initial plasma target concentration of propofol TCI is 2.0 渭 g / ml. With the aging of society and the increase of lung cancer in the elderly, Elderly people become the main people for fiberoptic bronchoscopy. Elderly patients with poor cardiopulmonary compensatory function, often associated with other diseases, fibrobronchoscopy is easy to cause violent fluctuations in the circulatory system. The optimal initial plasma target concentration of propofol TCI for fibrobronchoscopy in elderly patients was not clear. In this study, two different initial plasma target concentrations of propofol TCI were compared in elderly patients. The safety and effectiveness of bronchoscopy, Objective to study the suitable initial plasma target concentration of propofol TCI during fiberoptic bronchoscopy in elderly patients. Methods A randomized design was adopted in this study. 64 patients undergoing fiberoptic bronchoscopy were randomly divided into two groups before entering the room by digital table method. The initial plasma target concentration of propofol (1.0 渭 g / ml) and propofol initial plasma target concentration (2.0 渭 g / ml) in group B. the patients with propofol were treated with nasal cavity and oral cavity by nasal catheter oxygen inhalation 4-6 L / min. The larynx and subglottic subglottic anesthesia were given, followed by target controlled infusion, remifentanil effect chamber target concentration 0.8 ng / ml, propofol plasma target concentration 1.0 渭 g / ml or 2.0 渭 g / ml target controlled infusion. When the effect chamber concentration reaches the target plasma target concentration, the test begins, the sedation level is recorded, and the drug is stopped at the end of the test. The changes in the patient's vital signs are recorded. Anesthetic induction time (from anesthesia induction to the beginning of the examination, examination duration and recovery time, dosage of lidocaine, vasoactive drugs and propofol) were compared to compare the incidence of adverse reactions (hypoxemia and hypotension) between the two groups. Results the incidence of hypoxemia in group A was significantly lower than that in group B (P 0.05), and the times of placing oropharyngeal airway in group A was significantly less than that in group B (P 0.05). The frequency of hypotension in group A was lower than that in group B (P 0.05). The use of vasoactive drugs in group A was significantly lower than that in group B (P 0.05). The MOAA/S score of group A was significantly lower than that of group B (P 0.05). The maintenance target concentration of 1.6 卤0.2 渭 g / ml was significantly higher than that of group A (1.1 卤0.3 渭 g / ml), the difference was statistically significant. The induction time of anesthesia in group B was significantly higher than that in group A (1.1 卤0.3 渭 g / ml). The recovery time was significantly longer than that in group A (P 0.05), but the satisfaction score of group B was slightly higher than that of group A (P 0.046). Conclusion the initial target concentration of propofol at a low dose of 1 渭 g / ml can meet the need of sedation in elderly patients undergoing fiberoptic bronchoscopy. And less drug use, less adverse reactions during the operation, more safe anesthesia management.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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