右美托咪定或咪达唑仑复合羟考酮用于经支气管镜超声引导针吸活检术的麻醉效果比较

目的比较右美托咪定或咪达唑仑复合羟考酮用于经支气管镜超声引导针吸活检术(EBUS-TBNA)的镇静镇痛效果,以及对循环和呼吸功能的影响。方法选择纵隔淋巴结肿大择期行EBUS-TBNA患者60例,男33例,女27例,年龄18~65岁,BMI 18~24 kg/m^2,ASAⅠ或Ⅱ级,随机分为右美托咪定组(D组)和咪达唑仑组(M组),每组30例。入组患者均接受利多卡因口、鼻、咽部和环甲膜穿刺表面麻醉,D组于10 min内静脉泵注右美托咪定,负荷剂量为0.8μg/kg,继而以0.6μg·kg^-1·h^-1的速率维持泵入;M组以2 mg/min的速度静脉注射咪达唑仑0.05mg/kg。随后两组均静脉注射羟考酮0.08mg/kg。记录给药前(T0)、手术开始时(T1)、手术开始后5 min(T2)、10 min(T3)、15 min(T4)和术毕(T5)时的HR、SBP、DBP、SpO2,记录T1时Ramsay镇静评分、咳嗽评分,术毕时医师满意度和术后2 h患者满意度等指标。结果 T1时M组SpO2低于D组,但两组差异无统计学意义。T5时D组SBP明显低于M组(P<0.05)。与M组比较,D组Ramsay镇静评分、咳嗽评分明显降低(P<0.05),患者满意度中术中不适种类个数明显减少(P<0.05),愿意接受复查评分明显降低(P<0.05)。结论右美托咪定复合羟考酮用于EBUS-TBNA手术,患者咳嗽少,镇静适度,呼吸和循环更稳定,咪达唑仑复合羟考酮术后患者愿意接受复查的程度更高。

Comparison of anesthetic effects between dexmedetomidine or midazolam combined with oxycodone in the endobronchial ultrasound-guided transbronchial needle aspiration

Objective To compare the sedative and analgesic effects of dexmedetomidine or midazolam combined with oxycodone in the endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA), as well as the effects on circulation and respiratory functions. Methods Sixty patients with mediastinal lymphadenopathy, 33 males and 27 females, aged 18-65 years, with a BMI 18-24 kg/m^2, falling into ASA physical status Ⅰ or Ⅱ, were selected for EBUS-TBNA. The patients were randomly divided into two groups: dexmedetomidine group(group D) and midazolam group(group M), and each group contains 30 patients. All patients received the surface anesthesia with 2% lidocaine in the mouth, nose, pharynx and the ring-shaped membrane. In group D, dexmedetomidine was initially infused at 0.8μg/kg for 10 min, followed by continous infusion(0.6 μg·kg^-1·h^-1). In group M midazolam(0.05 mg/kg) was intravenously injected at a rate of 2 mg/min. Subsequently, the two groups of patients were intravenously injected with oxycodone(0.08 mg/kg). The HR, SBP, DBP, SpO2 were recorded at the following time points: before induction(T0), at the beginning of operation(T1), 5 min(T2), 10 min(T3) and 15 min(T4) after operation started and at the end of operation(T5). Ramsay sedation score, cough score, the satisfaction of the physician at the end of the operation and the satisfaction of the patient were recored at 2 h after surgery. Results The SpO2 in group M was lower than that in group D at T1, but there was no significant difference between two groups. The SBP in group D was significantly lower than that in group M at T5(P < 0.05). The Ramsay sedation score in group D was significantly lower than that in group M(P < 0.05). Compared with group M, the cough score of the D group was significantly lower(P < 0.05), and the number of intraoperative discomfort types was significantly reduced(P < 0.05). Compared to group D, more patients in group M would like to undergo re-examination(P < 0.05). Conclusion EBUS-TBNA surgery, the patients administrated with dexmedetomidine combined with oxycodone had less cough, moderate sedation, less respiratory depression,more stable blood pressure, and the patients administrated with midazolam combined with oxycodone were more willing to re-examination.