Wu Xinyu, Zhang Lina, Zhou Zangong, Qi Lijie, Liu Yinhuan, Du Xuebin, Ma Lixia, Ji Xiangyu
Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China.
Department of Anesthesiology, Qingdao Municipal Hospital, Qingdao, Shandong, People's Republic of China.
Ther Clin Risk Manag. 2024 Dec 12;20:849-860. doi: 10.2147/TCRM.S495253. eCollection 2024.
We conducted a prospective, real-world study to evaluate the efficacy and safety of balanced propofol sedation (BPS) in bronchoscopy and identify an advantageous sedation regimen for such procedures.
The participants were placed in four groups based on their sedation regimen (exposure factor): the M-S group (midazolam + sufentanil for traditional sedation), R-S group (remimazolam + sufentanil for traditional sedation), M-S-P group (midazolam + sufentanil + propofol for BPS), and R-S-P group (remimazolam + sufentanil + propofol for BPS). The primary outcomes included satisfaction metrics (satisfaction of the patients, endoscopic physicians, and nurses) and follow-up questionnaires. The secondary outcomes included time metrics (induction time, recovery time, and discharge time), dosage metrics (induction dose, maintenance dose, and total dose of each sedative), completion rate of sedation, intraprocedural dose, and frequency of lidocaine spray in the airway, and incidence of adverse reactions.
In total, 418 subjects were included in this study. Compared to traditional sedation, both BPS groups significantly increased the satisfaction of patients, endoscopic physicians, and nurses (P < 0.05) and reduced the incidence of intraprocedural wakefulness (P < 0.05). Additionally, induction and recovery of the BPS group were rapid, with high sedation completion rates and no increase in the incidence of intraprocedural and postprocedural adverse reactions (P < 0.05). The RSP group was better than the MSP group in terms of various time metrics and postprocedural adverse reactions.
BPS can be safely and effectively applied during bronchoscopy, with remimazolam and sufentanil combined with a small dose of propofol being an optimal medication regimen.
我们开展了一项前瞻性的真实世界研究，以评估支气管镜检查中平衡丙泊酚镇静（BPS）的疗效和安全性，并确定适用于此类操作的有利镇静方案。
根据镇静方案（暴露因素）将参与者分为四组：M-S组（咪达唑仑+舒芬太尼用于传统镇静）、R-S组（瑞米唑仑+舒芬太尼用于传统镇静）、M-S-P组（咪达唑仑+舒芬太尼+丙泊酚用于BPS）和R-S-P组（瑞米唑仑+舒芬太尼+丙泊酚用于BPS）。主要结局包括满意度指标（患者、内镜医师和护士的满意度）以及随访问卷。次要结局包括时间指标（诱导时间、恢复时间和出院时间）、剂量指标（每种镇静剂的诱导剂量、维持剂量和总剂量）、镇静完成率、术中剂量、气道内利多卡因喷雾频率以及不良反应发生率。
本研究共纳入418名受试者。与传统镇静相比，两个BPS组均显著提高了患者、内镜医师和护士的满意度（P<0.05），并降低了术中清醒的发生率（P<0.05）。此外，BPS组的诱导和恢复迅速，镇静完成率高，且术中及术后不良反应的发生率没有增加（P<0.05）。在各项时间指标和术后不良反应方面，R-S-P组优于M-S-P组。
BPS可在支气管镜检查期间安全有效地应用，瑞米唑仑和舒芬太尼联合小剂量丙泊酚是最佳用药方案。
