抑制应激反应和自主呼吸：靶控输注瑞芬太尼联合右美托咪定用于重度气管狭窄患者纤维支气管镜检查的监护麻醉效果及安全性

Inhibition of stress and spontaneous respiration: Efficacy and safety of monitored anesthesia care by target-controlled infusion remifentanil in combination with dexmedetomidine in fibreoptic bronchoscopy for patients with severe tracheal stenosis.

作者信息

Zhou Yi, Wu Wei, Zhu Yuanjie, Lv Xin, Liu Jianming

机构信息

School of Life Sciences and Technology, Tongji University, Shanghai, China.

Department of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, China.

出版信息

Front Med (Lausanne). 2022 Oct 31;9:972066. doi: 10.3389/fmed.2022.972066. eCollection 2022.

DOI:10.3389/fmed.2022.972066

PMID:36388940

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9659885/

Abstract

OBJECTIVE

This study aimed to determine the effective concentration of target-controlled infusion (TCI) of remifentanil used to inhibit stress during the treatment of severe tracheal stenosis with fibreoptic bronchoscopy and to evaluate the monitored anesthesia care (MAC) by remifentanil.

MATERIALS AND METHODS

60 patients with severe tracheal stenosis who underwent fibreoptic bronchoscopy was performed. Dexmedetomidine was initially administered at a bolus dose (0.8 mcg/kg), followed by a 0.5 mcg/(kg⋅h) continuous infusion. Remifentanil was administered by TCI. The effective concentration (EC) of remifentanil was titrated by the improved sequential method, and 30 patients were included. The EC95 of remifentanil was set as the plasma target concentration to evaluate the safety of the MAC, and another 30 patients were included.

RESULTS

The half effective effect-chamber concentration of remifentanil (EC50) was 2.243 ng/ml, and the EC95 was 2.710 ng/ml. Among the 30 patients who received an EC95 of remifentanil as the target concentration, one patient was remedied by injecting propofol, the score of Ramsay sedation was three. The incidence of subclinical hypoxemia (SPO of 90-95%) was 30%, the incidence of moderate hypoxemia (SPO of 75-89%, ≤60 s) was 20 and 86.7% of patients with oxygen saturation was less than 95% returned to normal by awakening. The satisfaction score of the operator was nine, the satisfaction score of the anesthesiologist was eight, the satisfaction score of the patients was 10, the rate of patient willingness to re-accept the procedure was 93.3% and the circulation was stable during the operation.

CONCLUSION

MAC using TCI of remifentanil with continuous pumping dexmedetomidine can effectively inhibit the stress response to fibreoptic bronchoscopy in patients with severe tracheal stenosis while maintaining spontaneous breathing. Under the anesthesia management of an experienced anesthesiologist, it provides a reference to tracheoscopic anesthesia of autonomous breathing.

CLINICAL TRIAL REGISTRATION

[http://www.chictr.org.cn/], identifier [ChiCTR 2100043380].

摘要

目的

本研究旨在确定瑞芬太尼靶控输注（TCI）用于抑制纤维支气管镜治疗重度气管狭窄时应激反应的有效浓度，并评估瑞芬太尼的监测麻醉管理（MAC）。

材料与方法

选取60例行纤维支气管镜检查的重度气管狭窄患者。首先静脉注射负荷剂量右美托咪定（0.8μg/kg），随后以0.5μg/（kg·h）持续输注。瑞芬太尼采用TCI给药。采用改良序贯法滴定瑞芬太尼的有效浓度（EC），纳入30例患者。将瑞芬太尼的EC95设定为血浆靶浓度以评估MAC的安全性，再纳入30例患者。

结果

瑞芬太尼的半数有效效应室浓度（EC50）为2.243ng/ml，EC95为2.710ng/ml。在以瑞芬太尼EC95为靶浓度的30例患者中，1例患者经注射丙泊酚补救，Ramsay镇静评分3分。亚临床低氧血症（SPO₂为90%~~95%）发生率为30%，中度低氧血症（SPO₂为75%~~89%，持续时间≤60s）发生率为20%，86.7%氧饱和度低于95%的患者苏醒后恢复正常。术者满意度评分为9分，麻醉医生满意度评分为8分，患者满意度评分为10分，患者愿意再次接受该操作的比例为93.3%，术中循环稳定。