Greig J H, Cooper S M, Kasimbazi H J, Monie R D, Fennerty A G, Watson B
Chest Clinic, Southern General Hospital, Glasgow, U.K.
Respir Med. 1995 Jan;89(1):53-6. doi: 10.1016/0954-6111(95)90071-3.
Most current sedative regimens for fibre optic bronchoscopy use an opioid, a benzodiazepine or a combination of both. This study compares midazolam (M) (a benzodiazepine), alfentanil (A) (an opioid) and a combination of both drugs (M+A). One hundred and three patients were randomized in double-blind manner into groups M(35), A(33) and M+A(35). The number of coughs, number of additional aliquots of lignocaine and duration of the procedures were recorded along with oxygen desaturation. The patient's level of discomfort was assessed by patient and bronchoscopist and expressed as a visual analogue score. There were significantly fewer coughs per minute in Group A compared with Group M (P = 0.0053), and significantly less lignocaine was required in Group A (P = 0.005) and in Groups M+A (P < 0.002) compared with Group M. There was no significant difference in the assessment of discomfort between the groups. There was a trend for Group M+A to desaturate more than the other two with a significant difference between desaturation in Group M+A and Group A (P = 0.033). Alfentanil is a more effective anti-tussive agent than midazolam for outpatient fibre optic bronchoscopy. The combination of alfentanil and midazolam does not provide any better anti-tussive effect and may have the risk of a greater degree of desaturation secondary to increased sedation.
目前，大多数用于纤维支气管镜检查的镇静方案使用阿片类药物、苯二氮䓬类药物或两者联合使用。本研究比较了咪达唑仑（M）（一种苯二氮䓬类药物）、阿芬太尼（A）（一种阿片类药物）以及两种药物的联合使用（M+A）。103例患者以双盲方式随机分为M组（35例）、A组（33例）和M+A组（35例）。记录咳嗽次数、利多卡因追加量、操作持续时间以及氧饱和度下降情况。由患者和支气管镜检查医师评估患者的不适程度，并以视觉模拟评分表示。与M组相比，A组每分钟咳嗽次数显著减少（P = 0.0053），A组（P = 0.005）和M+A组（P < 0.002）所需的利多卡因明显少于M组。各组之间在不适评估方面无显著差异。M+A组有比其他两组更易出现氧饱和度下降的趋势，M+A组与A组的氧饱和度下降情况有显著差异（P = 0.033）。对于门诊纤维支气管镜检查，阿芬太尼作为镇咳药比咪达唑仑更有效。阿芬太尼与咪达唑仑联合使用并未提供更好的镇咳效果，且可能因镇静作用增强而有导致更高程度氧饱和度下降的风险。
