不同剂量右美托咪定复合丙泊酚在老年肺结核支气管镜检查中的效果观察

Effect of different dose of dexmedetomidine combined with propofol in bronchoscopy for elderly patients with pulmonary tuberculosis

摘要:

目的 探讨不同剂量右美托咪定复合丙泊酚在老年肺结核支气管镜检查中的效果。方法 选取2021年4月—2023年4月南京市第二医院收治的150例老年肺结核患者为研究对象，按照随机数字表法分为A、B、C组，各50例。支气管镜检查中，A组给予0.5 μg/（kg·h）右美托咪定复合丙泊酚维持麻醉，B组给予1.0 μg/（kg·h）右美托咪定复合丙泊酚维持麻醉，C组给予丙泊酚维持麻醉。比较3组患者的镜检时间、意识消失时间、苏醒时间、丙泊酚用量及麻醉效果，3组患者麻醉开始前（T₀）、支气管镜进入声门（T₁）、支气管镜检查时（T₂）、支气管镜撤出后（T₃）的心率（HR）和平均动脉压（MAP），支气管镜检查前后白细胞介素-1β（IL-1β）、白细胞介素-18（IL-18）、去甲肾上腺素（NE）、超氧化物歧化酶（SOD）、谷胱甘肽过氧化物酶（GSH-Px）的差值，以及不良反应发生情况。结果 A组、B组意识消失时间、苏醒时间短于C组（P <0.05），丙泊酚用量少于C组（P <0.05），A组苏醒时间短于B组（P <0.05）；A组、B组意识消失时间、丙泊酚用量比较，差异均无统计学意义（P >0.05）。A组、B组优良率高于C组（P <0.05）。A组、B组、C组在T₀、T₁、T₂、T₃时点的HR、MAP比较，采用重复测量设计的方差分析，结果 ①不同时间点的HR、MAP比较，差异有统计学意义（F =4.775和6.121，均P =0.000）；②3组HR、MAP比较，差异有统计学意义（F =9.349和8.942，均P =0.000）；③3组HR、MAP变化趋势比较，差异有统计学意义（F =5.633和6.174，均P =0.000）。A组、B组检查前后IL-1β、IL-18、NE、SOD、GSH-Px的差值均低于C组（P <0.05），B组均低于A组（P <0.05）。A组、B组不良反应总发生率低于C组（P <0.05），A组不良反应总发生率低于B组（P <0.05）。结论 不同剂量右美托咪定在老年肺结核支气管镜检查中均有一定麻醉效果，可减少丙泊酚用量，与1.0 μg/（kg·h）相比，0.5 μg/（kg·h）右美托咪定复合丙泊酚维持麻醉，患者苏醒更快、体征更平稳、不良反应更少。

Abstract:

Objective To evaluate the effects of different doses of dexmedetomidine combined with propofol during bronchoscopic examinations in elderly patients with pulmonary tuberculosis.Methods From April 2021 to April 2023, 150 elderly patients with pulmonary tuberculosis treated at Nanjing Second Hospital were selected and randomly divided into three groups (A, B, C), each with 50 patients. During bronchoscopic examinations, Group A received dexmedetomidine at 0.5 μg/(kg·h) combined with propofol for maintenance anesthesia, Group B received 1.0 μg/(kg·h), and Group C received propofol alone. We compared bronchoscopy duration, time to loss of consciousness, recovery time, propofol dosage, anesthesia quality, heart rate (HR), mean arterial pressure (MAP) at various time points (T₀, T₁, T₂, T₃), changes in interleukin-1β (IL-1β), interleukin-18 (IL-18), norepinephrine (NE), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) before and after examination, and incidence of adverse reactions.Results The time to loss of consciousness and recovery time were shorter in Groups A and B compared to Group C (P <0.05), with Group A having shorter recovery time than Group B (P <0.05). Propofol usage was less in Groups A and B compared to Group C (P <0.05). There was no statistical significance among above indicies between Group A and Group B (P >0.05). The quality of anesthesia was superior in Groups A and B (P <0.05). Repeated measures ANOVA showed significant differences in HR and MAP across different time points (F =4.775 and 6.121, both P =0.000) and among the groups (F =9.349 and 8.942, both P =0.000), there were significant differences in HR and MAP trends among the three groups (F =5.633 and 6.174, both P =0.000). The changes in IL-1β, IL-18, NE, SOD, GSH-Px were lower in Groups A and B compared to Group C (P <0.05), with Group B being lower than Group A (P <0.05). The overall incidence of adverse reactions was lower in Groups A and B compared to Group C (P <0.05), with Group A having fewer adverse reactions than Group B (P < 0.05).Conclusion Different doses of dexmedetomidine have an effective anesthetic impact in bronchoscopic examinations of elderly patients with pulmonary tuberculosis, reducing the need for propofol. Compared to 1.0 μg/(kg·h), 0.5 μg/(kg·h) of dexmedetomidine combined with propofol results in faster recovery, more stable vital signs, and fewer adverse reactions.