Webb A R, Doherty J F, Chester M R, Cummin A R, Woodhead M A, Nanson E M, Flack S T, Millard F J
St. James' Hospital, Balham, London, U.K.
Respir Med. 1989 May;83(3):213-7. doi: 10.1016/s0954-6111(89)80034-4.
Sedation for fibreoptic bronchoscopy should produce optimal conditions for the operator, patient comfort and rapid recovery allowing early discharge home. We have compared a regimen producing 'light' sedation with a more traditional regimen producing 'deep' sedation. Seventy-six patients undergoing fibreoptic bronchoscopy under topical anaesthesia were randomized to receive either light sedation with the short acting opiate, alfentanil (median dose 1.1 mg, range 0.5-2.6 mg) or deep sedation with a combination of papaveretum (median dose 10 mg, range 5-15 mg) and diazepam (median dose 8 mg, range 0-20 mg). Both techniques gave equally good operating conditions, although patients given alfentanil coughed less than those given papaveretum and diazepam (U = 2.814 P less than 0.01). Patients recorded their degree of apprehension on a visual analogue scale prior to sedation and the actual degree of comfort experienced after recovery. There was no significant difference between apprehension or comfort between the groups. This was despite a higher degree of amnesia for an irrelevant object shown during the bronchoscopy in the deeply sedated group (chi 2 = 21.084 P less than 0.001). Patients given alfentanil performed significantly better in a modified Romberg test (chi 2 = 4.357 P less than 0.05) and a visualisation test (t = 3.035 P less than 0.01) two hours after the bronchoscopy. Alfentanil produced good operating conditions, patient comfort, less cough and a more rapid recovery, compared to the deep sedation regimen, and is an ideal sedative for fibreoptic bronchoscopy.
纤维支气管镜检查的镇静应能为操作者创造最佳条件，让患者感到舒适并能快速恢复，以便早期出院回家。我们比较了一种产生“轻度”镇静的方案与一种更传统的产生“深度”镇静的方案。76例在局部麻醉下接受纤维支气管镜检查的患者被随机分配，分别接受短效阿片类药物阿芬太尼（中位剂量1.1毫克，范围0.5 - 2.6毫克）的轻度镇静，或接受吗啡（中位剂量10毫克，范围5 - 15毫克）与地西泮（中位剂量8毫克，范围0 - 20毫克）联合使用的深度镇静。尽管接受阿芬太尼的患者咳嗽比接受吗啡和地西泮的患者少（U = 2.814，P < 0.01），但两种技术都提供了同样良好的操作条件。患者在镇静前用视觉模拟量表记录其焦虑程度，并在恢复后记录实际体验到的舒适程度。两组之间在焦虑或舒适度方面没有显著差异。尽管在深度镇静组中，患者对支气管镜检查期间展示的无关物体的遗忘程度更高（χ² = 21.084，P < 0.001）。在支气管镜检查两小时后，接受阿芬太尼的患者在改良罗姆伯格试验（χ² = 4.357，P < 0.05）和视觉化试验（t = 3.035，P < 0.01）中表现明显更好。与深度镇静方案相比，阿芬太尼产生了良好的操作条件、患者舒适度、较少的咳嗽以及更快的恢复，是纤维支气管镜检查的理想镇静剂。
