CAJ | 학술논문

目的探讨右美托咪定复合靶控输注(TCI)异丙酚-瑞芬太尼用于老年患者纤维支气管镜检查术的效果.方法择期行纤维支气管镜检查术的老年患者40例,性别不限,ASA分级Ⅱ或Ⅲ级,年龄65 ～ 75岁,BMI 20～30 kg/m2,采用随机数字表法,将患者随机分为2组(n=20):生理盐水对照组(C组)和右美托咪定组(D组).麻醉诱导前10 min D组静脉注射右美托咪定负荷剂量0.5μg/kg,随后以0.5 μg·kg-1·h-1的速率维持至检查结束,C组给予等容量生理盐水.麻醉诱导时TCI异丙酚(效应室靶浓度为3 μg/ml),待血浆-效应室浓度平衡后开始TCI瑞芬太尼(效应室靶浓度为4ng/ml),待患者意识消失后置入纤维支气管镜,入镜后调整异丙酚效应室靶浓度至1～3 μg/ml、瑞芬太尼效应室靶浓度至2～4 ng/ml.于麻醉诱导前(T0)、麻醉诱导后即刻(T1)、纤维支气管镜进入声门即刻(T2)、到达隆突即刻(T3)、检查完成即刻(T4)、检查完成后10 min(T)时记录MAP、HR和警觉镇静评分(OAA/S评分),记录异丙酚和瑞芬太尼的用量、检查时间、苏醒时间以及检测期间心血管不良反应、低氧血症、恶心呕吐、反流误吸等不良反应的发生情况.结果与C组比较,D组T5时OAA/S评分明显升高,异丙酚和瑞芬太尼用量减少,苏醒时间缩短,低血压和低氧血症发生率降低(P＜0.05).2组均未出现恶心呕吐、反流误吸等严重不良反应.结论右美托咪定(给予负荷剂量0.5 μg/kg后以0.5μg·kg-1·h-1维持输注)复合TCI异丙酚-瑞芬太尼可安全有效地用于老年患者纤维支气管镜检查.
목적 탐토우미탁미정복합파공수주(TCI)이병분-서분태니용우노년환자섬유지기관경검사술적효과.방법 택기행섬유지기관경검사술적노년환자40례,성별불한,ASA분급Ⅱ혹Ⅲ급,년령65 ～ 75세,BMI 20～30 kg/m2,채용수궤수자표법,장환자수궤분위2조(n=20):생리염수대조조(C조)화우미탁미정조(D조).마취유도전10 min D조정맥주사우미탁미정부하제량0.5μg/kg,수후이0.5 μg·kg-1·h-1적속솔유지지검사결속,C조급여등용량생리염수.마취유도시TCI이병분(효응실파농도위3 μg/ml),대혈장-효응실농도평형후개시TCI서분태니(효응실파농도위4ng/ml),대환자의식소실후치입섬유지기관경,입경후조정이병분효응실파농도지1～3 μg/ml、서분태니효응실파농도지2～4 ng/ml.우마취유도전(T0)、마취유도후즉각(T1)、섬유지기관경진입성문즉각(T2)、도체륭돌즉각(T3)、검사완성즉각(T4)、검사완성후10 min(T)시기록MAP、HR화경각진정평분(OAA/S평분),기록이병분화서분태니적용량、검사시간、소성시간이급검측기간심혈관불량반응、저양혈증、악심구토、반류오흡등불량반응적발생정황.결과 여C조비교,D조T5시OAA/S평분명현승고,이병분화서분태니용량감소,소성시간축단,저혈압화저양혈증발생솔강저(P＜0.05).2조균미출현악심구토、반류오흡등엄중불량반응.결론 우미탁미정(급여부하제량0.5 μg/kg후이0.5μg·kg-1·h-1유지수주)복합TCI이병분-서분태니가안전유효지용우노년환자섬유지기관경검사.
Objective To investigate the efficacy of dexmedetomidine combined with target-controlled infusion (TCI) of propofol and remifentanil for fiberoptic bronchoscopy in the elderly patients.Methods Forty ASA Ⅱ or Ⅲ patients,aged 65-75 yr,with body mass index of 20-30 kg/m2,scheduled for elective fiberoptic bronchoscopy,were randomly divided into 2 groups (n =20 each):control group (group C) and dexmedetomidine group (group D).In group D,a loading dose of dexmedetomidine 0.5/μg/kg was injected at 10 min before induction of anesthesia,followed by infusion at 0.5 μg· kg-1 · h-1 until the end of fiberoptic bronchoscopy.While the equal volume of normal saline was given instead in group C.Anesthesia was induced with TCI of propofol and remifentanil.The target effect-site concentration (Ce) of propofol was 3 μg/ml.When the plasma concentration and Ce were balanced,TCI of remifentanil (target Ce 4 ng/ml) was started.The fiberoptic bronchoscope was placed after consciousness was lost and then the Ces of propofol and remifentanil were adjusted to 1-3 μg/ml and 2-4 ng/ml,respectively.MAP,HR and OAA/S score were recorded before induction (T0),immediately after induction (T1),when the tip of fiberoptic bronchoscope reached the glottis (T2) and carina (T3),at the end of bronchoscopy (T4)and 10 min after the end of bronchoscopy (T5).The consumption of propofol and remifentanil,duration of bron-choscopy,emergence time,adverse cardiovascular events and side effects such as hyoxemia,nausea and vomiting,regurgitation and aspiration were recorded.Results Compared with group C,OAA/S score at T5 and the consumption of propofol and remifentanil was reduced,and emergence time was shortened,and the incidence of hypotension and hyoxemia was decreased in group D (P ＜ 0.05).No patients developed side effects such as hyoxemia,nausea and vomiting,regurgitation and aspiration in both groups.Conclusion Dexmedetomidine (infusion at 0.5 μg·kg-1 ·h-1 after a loading dose of 0.5 μg/kg) combined with TCI of propofol and remifentanil can be safely and effectively used for fiberoptic bronchoscopy in the elderly patients.