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瑞芬太尼联合瑞马唑仑在保留自主呼吸非插管全身麻醉纤维支气管镜中的应用效果

Application effect of remifentanil combined with remimazolam in non-intubated general anesthesia fiberoptic bronchoscopy with preserved spontaneous breathing

    摘要
  • 摘要:
    目的 探讨瑞马唑仑联合瑞芬太尼在保留自主呼吸非插管全身麻醉纤维支气管镜中的应用效果及对血流动力学指标的影响。
    方法 选取114例行保留自主呼吸非插管全身麻醉纤维支气管镜的患者, 随机分为对照组和试验组, 每组57例。对照组静脉滴注30 μg右美托咪定并静脉缓慢注射1~3 μg/kg瑞芬太尼, 试验组在对照组基础上静脉注射0.2 mg/kg瑞马唑仑。比较2组镜检前(T0)、纤维支气管镜进入气管时(T1)和镜检后3 min(T2)的心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO2); 观察T0和T2的NOD样受体热蛋白结构域相关蛋白3(NLRP3)、凋亡相关斑点样蛋白(ASC)、白细胞介素-1β(IL-1β)、白细胞介素-1(IL-1)水平; 记录2组麻醉和不良反应情况。
    结果 T0~T2, 试验组HR、MAP、SpO2水平变化幅度小于对照组, 差异有统计学意义(P < 0.05); T2时, 试验组NLRP3、ASC、IL-1β、IL-1水平低于对照组, 差异均有统计学意义(P < 0.05)。试验组诱导麻醉时间、离室时间短于对照组, 麻醉优良率高于对照组, 不良反应发生率低于对照组, 差异均有统计学意义(P < 0.05)。
    结论 瑞马唑仑联合瑞芬太尼在保留自主呼吸非插管全身麻醉纤维支气管镜中可抑制炎症因子释放, 稳定血流动力学指标水平, 降低不良反应发生率。

     

    Abstract:
    Objective To explore the application effect of remimazolam combined with remifentanil in non-intubated general anesthesia fiberoptic bronchoscopy with preserved spontaneous breathing and its influence on hemodynamic indicators.
    Methods A total of 114 non-intubated general anesthesia fiberoptic bronchoscopy patients with preserved spontaneous breathing were selected and randomly divided into control group and trial group, with 57 cases in each group. The control group was intravenously dripped with 30 μg dexmedetomidine and slowly injected with 1 to 3 μg/kg remifentanil, while the trial group was intravenously injected with 0.2 mg/kg remimazolam on the basis of the control group. The heart rate (HR), mean arterial pressure (MAP) and blood oxygen saturation (SpO2) were compared between the two groups at the time points of before bronchoscopy (T0), immediately entering the trachea (T1) and 3 minutes after bronchoscopy (T2); the levels of NOD-like receptor thermal protein domain associated protein 3 (NLRP3), apoptosis-related speckle-like protein(ASC), interleukin-1β (IL-1β) and interleukin-1 (IL-1) were observed at T0 and T2; the anesthesia and adverse reactions in both groups were recorded.
    Results From T0 to T2, the increasing and decreasing degrees of HR, MAP and SpO2 levels in the trial group were significantly smaller than those in the control group (P < 0.05); at T2, the NLRP3, ASC, IL-1β and IL-1 levels in the trial group were significantly lower than those in the control group (P < 0.05). The induction anesthesia time and the time of leaving the room in the trial group were significantly shorter than those in the control group, the excellent and good rate of anesthesia was significantly higher than that in the control group, and the incidence of adverse reactions was significantly lower than that in the control group (P < 0.05).
    Conclusion In non-intubated general anesthesia fiberoptic bronchoscopy patients with preserved spontaneous breathing, remimazolam combined with remifentanil can inhibit the releases of inflammatory factors, stabilize the levels of hemodynamic indicators and reduce the incidence of adverse reactions.

     

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