Comparison of painless fiberoptic bronchoscopy with different doses of alfentanil combined with propofol
不同剂量阿芬太尼复合丙泊酚行无痛纤支镜检查效果的比较

摘要

目的 评价不同剂量阿芬太尼和丙泊酚用于无痛线镜检查的麻醉效果。方法 选择2020年10月~2021年4月择期行无痛纤支镜检查术的患者66例，ASA Ⅰ或Ⅱ级，入选患者按随机数表法分为3组：A组（静脉推注阿芬太尼1 μg/kg后静脉推注丙泊酚1.5~2mg/kg）、B组（静脉推注阿芬太尼3μg/kg后静脉推注丙泊酚1.5~2mg/kg）和C组（静脉推注阿芬太尼5 μg/kg后静脉推注丙泊酚1.5~2mg/kg）。若患者在气管纤支镜检查时发生睫毛反射或身体运动、呛咳等反应，则需额外补充丙泊酚0.2~0.5mg/kg。对3组病人的丙泊酚总用量进行记录；病人恢复清醒的时间；不良事件的发生，如呛咳，肢体运动，呼吸抑制，循环抑制；持续监测血压、脉搏及氧饱和度，对纤支镜操作总时间和呼吸内科医生手术的满意度进行记录。 结果 丙泊酚在B组和C组中的总用量、苏醒时间和呛咳发生率均较A组显著降低(P<0.05)，呼吸内科医生的满意度较A组显著提高；呼吸抑制在A组和B组中的发生率比C组低(P<0.05)。循环抑制在A组和B组中的发生率比C组低(P<0.05)，呼吸抑制和循环波动在B组中的发生率比C组低(P<0.05)。结论 阿芬太尼3 μg/kg复合丙泊酚1.5~2mg/kg诱导量较适合无痛纤支镜检查所需麻醉深度，适合门诊无痛纤支镜检查。

Abstract

Objective To evaluate the anesthetic effect of different doses of alfentanil combined with propofol in painless fiberoptic bronchoscopy.
Methods Sixty-six patients with ASA I-II undergoing elective fiberoptic bronchoscopy were randomly divided into groups A, B and C group. Alfentanil 1μg/kg(group A), 3μg/kg(group B) and 5μg/kg(group C) were given first, followed by propofol 1. 5 ~ 2mg/kg. The modified conscious sedation (MOAA/S) score was 0. During fiberoptic bronchoscopy, if the patient had eyelash reflex, body movement, or cough, propofol 0.2~0.5 mg/kg was administered. The total amount of propofol, recovery time, incidence of cough, body movement, respiratory depression and circulatory depression and other adverse events were recorded. Blood pressure, pulse and blood oxygen saturation were monitored and the operation time of fiberoptic bronchoscopy and doctor's satisfaction were also recorded.
Results The total dosage of propofol, recovery time and incidence of cough in groups B and C were significantly lower than those in group A (P＜0.05), and the satisfaction of doctors was significantly higher than that of group A (P＜0.05); The incidence of respiratory depression in group A and B was lower than that in group C (P＜0.05). The incidence of circulatory depression in group A and B was lower than that in group C (P＜0.05). Compared with group C, group B had lower respiratory depression and circulation fluctuation (P＜0.05).
Conclusion   Alfentanil 3μg/kg, combined with propofol 1.5 ~ 2mg/kg of induction is more suitable for painless fiberoptic bronchoscopy required depth of anesthesia, suitable for outpatient fiberoptic bronchoscopy.