【作者】 张莉；

【导师】 朱素洁；

【作者基本信息】 新疆医科大学 ， 麻醉学（专业学位）， 2025， 硕士

【摘要】 目的:探讨依托咪酯与瑞马唑仑联合丙泊酚用于无痛支气管镜检查的镇静效果。方法:选择择期行无痛支气管镜检查的患者90例,年龄18～65岁,ASA I～Ⅲ级,BMI<28 kg/m²,随机分为丙泊酚联合瑞马唑仑组（RP组,n=30）、丙泊酚联合依托咪酯组（EP组,n=30）和丙泊酚组（P组,n=30）。RP组静脉注射丙泊酚0.5 mg/kg+瑞马唑仑0.075 mg/kg+舒芬太尼0.1μg/kg;EP组静脉注射丙泊酚0.5 mg/kg+依托咪酯0.075 mg/kg+舒芬太尼0.1μg/kg;P组静脉注射丙泊酚1.0 mg/kg+舒芬太尼0.1μg/kg;待患者意识消失及睫毛反射消失,改良警觉/镇静评分（Modified observer’s assessment of alertness/sedation,MOAA/S）≤2分后,行经鼻纤维支气管镜检查,术者在检查过程中分次在声门、气管、左右主支气管经气管镜给予2%利多卡因共15ml进行表面麻醉。记录三组患者的呛咳评分、镇静起效时间、苏醒时间、血压、心率、舒适度评分、顺行性遗忘评分、医生满意度及不良反应发生情况。结果:三组患者呛咳评分、苏醒时间和追加次数上差异无统计学意义（P>0.05）;RP组镇静起效时间较EP组和P组快（P<0.05）;P组在T₂、T₃、T₄时的收缩压、舒张压、心率显著低于RP组与EP组（均P<0.05）;P组在T₃、T₄、T₅时的脉搏血氧饱和度显著低于RP组与EP组（均P<0.05）;RP组的舒适度评分和顺行性遗忘评分较EP组和P组低（P<0.05）,医生满意度较EP组和P组高（P<0.05）;RP组的注射痛、低血压、头晕、呼吸抑制的发生率显著低于P组（P<0.05）,RP组的恶心呕吐和肌颤的发生率显著低于EP组（P<0.05）;三组患者的心动过缓和呃逆发生率无统计学意义（P>0.05）。结论:丙泊酚联合瑞马唑仑、丙泊酚联合依托咪酯和单独使用丙泊酚均能满足无痛支气管镜检查的镇静需求,但是相对于单独使用丙泊酚,丙泊酚联合瑞马唑仑和丙泊酚联合依托咪酯能够减少检查过程中血流动力学的波动,丙泊酚联合瑞马唑仑的不良反应发生率较低,可安全有效地用于无痛支气管镜检查。更多还原

【Abstract】 Objective:To investigate the sedative effects of etomidate and remimazolam combined with propofol in painless bronchoscopy.Methods:Ninety patients scheduled for elective painless bronchoscopy,aged 18～65 years,ASA Ⅰ～Ⅲ,BMI<28 kg/m²,were randomly divided into three groups:propofol combined with remimazolam（RP group,n=30）,propofol combined with etomidate（EP group,n=30）,and propofol alone（P group,n=30）.The RP group received intravenous propofol 0.5 mg/kg+remimazolam 0.075mg/kg+sufentanil 0.1μg/kg;the EP group received propofol 0.5 mg/kg+etomidate0.075 mg/kg+sufentanil 0.1μg/kg;and the P group received propofol 1.0 mg/kg+sufentanil 0.1μg/kg.After loss of consciousness,disappearance of the eyelash reflex,and Modified Observer’s Assessment of Alertness/Sedation（MOAA/S）score≤2,transnasal fiberoptic bronchoscopy was performed.During the procedure,the operator administered15 m L of 2%lidocaine topically at the glottis,trachea,and main bronchi via the bronchoscope.Coughing scores,sedation onset time,recovery time,blood pressure,heart rate,comfort scores,anterograde amnesia scores,physician satisfaction,and adverse reactions were recorded.Results:No significant differences were observed among the three groups in coughing scores,recovery time,or additional sedative doses（P>0.05）.The sedation onset time in the RP group was shorter than that in the EP and P groups（P<0.05）.Systolic blood pressure（SBP）,diastolic blood pressure（DBP）,and heart rate（HR）at T₂,T₃,and T₄ in the P group were significantly lower than those in the RP and EP groups（P<0.05）.Pulse oxygen saturation（SpO₂）at T₃,T₄,and T₅ in the P group was significantly lower than in the RP and EP groups（P<0.05）.The RP group had lower comfort and anterograde amnesia scores but higher physician satisfaction compared to the EP and P groups（P<0.05）.The incidence of injection pain,hypotension,dizziness,and respiratory depression in the RP group was significantly lower than in the P group（P<0.05）,while nausea/vomiting and myoclonus rates in the RP group were lower than in the EP group（P<0.05）.No significant differences were observed in bradycardia or hiccup incidence among the groups（P>0.05）.Conclusion:Propofol combined with remimazolam,propofol combined with etomidate,and propofol alone all meet the sedation requirements for painless bronchoscopy.However,compared to propofol alone,the combination regimens（RP and EP groups）reduce hemodynamic fluctuations during the procedure.Notably,the propofol-remimazolam combination demonstrates a lower incidence of adverse reactions and can be safely and effectively applied in painless bronchoscopy.更多还原