CAJ | 학술논문

目的探讨在不需要麻醉科医师监护和特殊供氧条件下,小剂量咪达唑仑-芬太尼静脉复合麻醉在支气管镜检查中的作用及其对心、肺功能的影响.方法选取在我院接受支气管镜检查的患者共47例,分为2组:A组为1％丁卡因喷喉及2％利多卡因环甲膜穿刺法局部黏膜表面麻醉,共20例；B组为上述局部麻醉方式加用小剂量咪达唑仑-芬太尼静脉注射镇静镇痛,共27例.记录对比患者术中镇静分级、不良反应发生情况、术后满意度、遗忘程度,观察其麻醉前、麻醉后术前、术中进声门时及术后生命体征(心率、呼吸频率、血氧饱和度、平均动脉压)和术前、术后10 min、术后4h肺功能指标[用力肺活量(FVC)、第1秒用力呼气量(FEV1)、FEV1/FVC、最大呼气流量(PEF)]变化情况.结果 A、B两组在患者镇静分级、术中不良反应程度、术后遗忘程度及患者主观满意度四个方面差异具有统计学意义(P＜0.05),B组明显优于A组.两组肺功能指标FVC、FEV1及PEF在术后10 min均较术前下降,其中B组用力肺活量下降程度较A组更显著(P＜0.05)；两组术后4h的肺功能可回到基线水平.两组生命体征指标:A组内心率、呼吸频率、平均动脉压在术中进声门时及术后较麻醉前升高,且术中进声门时血氧饱和度较麻醉前下降( P＜0.05);而B组仅心率较麻醉前差异具有统计学意义,且A组术中进声门时心率和平均动脉压的升高程度均大于B组(P＜0.05).结论小剂量咪达唑仑-芬太尼复合麻醉在支气管镜麻醉效果方面明显优于传统局部麻醉方式,且对心血管系统及氧和方面的影响更小,对于术后4h肺功能各指标无附加影响；由于不需要专职麻醉医师监护管理以及其麻醉的有效性及安全性,更易于被医师及患者所接受,有利于其在临床推广.
목적 탐토재불수요마취과의사감호화특수공양조건하,소제량미체서륜-분태니정맥복합마취재지기관경검사중적작용급기대심、폐공능적영향.방법 선취재아원접수지기관경검사적환자공47례,분위2조:A조위1％정잡인분후급2％리다잡인배갑막천자법국부점막표면마취,공20례；B조위상술국부마취방식가용소제량미체서륜-분태니정맥주사진정진통,공27례.기록대비환자술중진정분급、불량반응발생정황、술후만의도、유망정도,관찰기마취전、마취후술전、술중진성문시급술후생명체정(심솔、호흡빈솔、혈양포화도、평균동맥압)화술전、술후10 min、술후4h폐공능지표[용력폐 활량(FVC)、제1초용력호기량(FEV1)、FEV1/FVC、최대호기류량(PEF)]변화정황.결과 A、B량조재환자진정분급、술중불량반응정도、술후유망정도급환자주관만의도사개방면차이구유통계학의의(P＜0.05),B조명현우우A조.량조폐공능지표FVC、FEV1급PEF재술후10 min균교술전하강,기중B조용력폐활량하강정도교A조경현저(P＜0.05)；량조술후4h적폐공능가회도기선수평.량조생명체정지표:A조내심솔、호흡빈솔、평균동맥압재술중진성문시급술후교마취전승고,차술중진성문시혈양포화도교마취전하강( P＜0.05);이B조부심솔교마취전차이구유통계학의의,차A조술중진성문시심솔화평균동맥압적승고정도균대우B조(P＜0.05).결론 소제량미체서륜-분태니복합마취재지기관경마취효과방면명현우우전통국부마취방식,차대심혈관계통급양화방면적영향경소,대우술후4h폐공능각지표무부가영향；유우불수요전직마취의사감호관리이급기마취적유효성급안전성,경역우피의사급환자소접수,유리우기재림상추엄.
Objective To evaluate the effects and influence of cardiac and pulmonary function by low doses of midazolam-fentanyl intravenous anesthesia in bronchoscopy.Methods Group A,total of 20cases,accepted local anesthesia with tetracaine and lidocaine ; group B,27 cases who accepted local anesthesia combined with low doses of midazolam-fentanyl intravenous anesthesia.To compare patients' sedation grade,the degree of adverse reactions,satisfaction and forgetfulness after examination between two groups,and to study the variation of vital sign (HR,RR,SaO2,MAP) before and after anesthesia,through the glottis and after examination,and variation of pulmonary function (FVC,FEV1,FEV1/FVC％,PEF) before anesthesia,10 min and 4 hours after bronchoscopy.Results Anesthetic effect of two groups was significantly different,group B was better than group A ( P ＜0.05).FVC,FEV1 and PEF of two groups at the time of 10 min after examination were all decreased than before examination.Change of the quantity of FVC in group A was less than group B (P ＜0.05).At the time of 4 h after examination,pulmonary function index could recover.In group A,HR,RR and MAP at the time points of through the glottis and after examination increased obviously than before anaesthsia ( P ＜0.05),and SaO2 at the time point of through the glottis decreased than before anaesthsia ( P ＜0.05) ; but in group B only HR increased.The fluctuations of HR and MAP through the glottis in group A were more obvious than group B ( P ＜0.05).Conclusions Anaesthetic effect of low doses of midazolam-fentanyl composite intravenous anesthesia is much better than traditional local anesthesia,and this method causes less influence of cardiovascular system and oxygenation and can not lead to significant additional effects on pulmonary function of 4 h after examination.No needing of professional anesthesiologist's monitoring will make this technology be accepted easier by patients and doctors and promoted greatly in clinic.