本文選題：纖維支氣管鏡　切入點(diǎn)：丙泊酚　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景及目的纖維支氣管鏡檢查(Fiberoptic bronchoscopy,FB)是目前呼吸系統(tǒng)疾病的確診和某些肺部疾患治療的首選方法,但其對(duì)咽喉及氣管有強(qiáng)烈的刺激。丙泊酚靶控輸注(target controlled infusion,TCI)操作簡(jiǎn)便,可控性好,血藥濃度穩(wěn)定,能為行纖維支氣管鏡檢查的患者提供較好的舒適性和快速蘇醒,目前已廣泛應(yīng)用。根據(jù)臨床經(jīng)驗(yàn)以及國(guó)內(nèi)外研究顯示丙泊酚TCI的起始血漿靶濃度為2.0μg/ml。隨著社會(huì)老齡化以及肺癌在高齡人群的增加,老年人成為纖支鏡檢查的主要人群。老年患者心肺代償功能差,常合并其他疾病,行纖維支氣管鏡檢查術(shù)時(shí)容易引起循環(huán)系統(tǒng)劇烈波動(dòng),誘發(fā)心血管不良反應(yīng)。而丙泊酚TCI用于纖支鏡檢的老年患者的適宜的起始血漿靶濃度目前尚不清楚。本研究對(duì)比了丙泊酚TCI的兩種不同起始血漿靶濃度在老年纖維支氣管鏡檢的安全性及有效性,擬探討老年患者行纖支鏡檢時(shí)丙泊酚TCI適宜的起始血漿靶濃度。方法本研究采取隨機(jī)設(shè)計(jì)。選擇行纖維支氣管鏡檢查的患者64例,入室前采用數(shù)字表法隨機(jī)分成兩組,丙泊酚起始血漿靶濃度1.0μg/ml(A組)和丙泊酚起始血漿靶濃度2.0μg/ml(B組)�；颊呷胧液箝_放靜脈通路,采取鼻導(dǎo)管吸氧4-6 L/min,利多卡因行鼻腔、口腔、咽喉部及聲門下充分表面麻醉。隨后進(jìn)行靶控輸注,瑞芬太尼效應(yīng)室靶濃度0.8ng/ml靶控輸注,丙泊酚血漿靶濃度1.0μg/ml或2.0μg/ml靶控輸注,當(dāng)效應(yīng)室濃度達(dá)到設(shè)定的目標(biāo)血漿靶濃度時(shí)開始進(jìn)行檢查,并記錄此時(shí)的鎮(zhèn)靜水平,檢查結(jié)束時(shí)即停止給藥。記錄患者生命體征的變化、麻醉誘導(dǎo)時(shí)間(從麻醉誘導(dǎo)到檢查開始的時(shí)間)、檢查持續(xù)時(shí)間以及蘇醒時(shí)間、利多卡因、血管活性藥及丙泊酚用量,比較兩組不良反應(yīng)(低氧血癥以及低血壓)發(fā)生率、患者及術(shù)者操作滿意度情況。結(jié)果低氧血癥的發(fā)生率,A組明顯低于B組,P0.05;對(duì)低氧血癥實(shí)行的臨床干預(yù)措施中,A組放置口咽通氣道的次數(shù)明顯少于B組,P0.05。術(shù)中出現(xiàn)低血壓的次數(shù)A組低于B組,P0.05。術(shù)中血管活性藥的使用方面,A組去氧腎上腺素的使用量明顯低于B組,P0.05。A組的MOAA/S評(píng)分高于B組,P0.05,有統(tǒng)計(jì)學(xué)差異。B組患者的丙泊酚術(shù)中維持靶濃度為1.6±0.2μg/ml,較A組(1.1±0.3μg/ml)有明顯升高,P0.05,差異有統(tǒng)計(jì)學(xué)意義。B組麻醉誘導(dǎo)時(shí)間、蘇醒時(shí)間明顯長(zhǎng)于A組,P0.05,有統(tǒng)計(jì)學(xué)差異。但B組的術(shù)者滿意度評(píng)分稍高于A組,P=0.046。結(jié)論在老年人行纖維支氣管鏡檢查時(shí),低劑量1μg/ml的丙泊酚起始靶濃度既能滿足鎮(zhèn)靜的需求,而且用藥量更少,術(shù)中不良反應(yīng)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 鹵0.2 渭 g / ml was significantly higher than that of group A (1.1 鹵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 鹵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.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R614

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