| Objective To research the effects of different doses of remifentanil Combined with Propofol Target Control Infusion at hemodynamic and body movement in Bronchoscopy.Methods Approval for the study was obtained from the institutional review board of Dalian municipal central hospital affiliated Dalian Medical University,90 patients of ASA physical status ? to ? and ages 18-65 years?Sex unlimited who were to undergo bronchoscopy during a span of 7 months(from January 2015 to June 2015).they were randomized into 3 groups,group A(target plasma concentration of remifentanil is 4ng/ml),group B(target plasma concentration of remifentanil is 6ng/ml),group C(target plasma concentration of remifentanil is 8ng/ml).Anesthesia induction start at the same time infusion of propofol and remifentanil,all patients were given propofol target plasma concentration are 4 ug/ml,group A,group B and group C target plasma concentration of remifentanil is 4?6 and 8ng/ml respectively,when the Narcotrend reach at D1,Insert the laryngeal mask connected T tube,connecting the anesthesia machine with mechanical ventilation,inhaled oxygen concentration was 100%,When blood concentration of remifentanil was up target concentration,start to operation.Adjust the dosage of propofol in order to maintain Narco trend stage at D1?E0,intraoperative blood pressure is lower than 20%of the basis of blood pressure,use to phenylephrineagent adjust,if the heart rate small 50 times/min,0,4 mg atropine intravenous injection.Intraoperative body movement response to level 4,from the fiber bronchoscope side hole injection of 2%lidocaine 3 ml.After the surgery to stop infusion of propofol and remifentanil,when the patient awake,pull out the laryngealmask,sent the patient into the recovery room.Record of three groups of patients with gender?age?height?weight?operation time,?wake up time and heart rate(HR),mean arterial pressure(MAP),pulse oxygen saturation(SPO2)were recorded at Ti(into the operating room)?T2(after induction immediately)?T3(10 min after operation)?T4(out of the operating room).Recorded.the number of additional atropine and lidocaine,the dosage of propofol?Body movement score?intraoperative awareness and laryngospasm were recorded.Results Complete perioperative data was available for only 86 of the 90 patients.group A(n=28)?group B(n=30)?group C(n=28).1.Three groups of patients with gende?age?height?weight?operation time?compare differences had no statistical significance.2.Compared with group A,The awakening time of group B and C group were lower thangroup A.There was no statistically significant difference between Group C and B.3.At T1,T2 time,three groups of heart rate,blood pressure,pulse oxygen saturation had no statistical significance?At T3 moment,heart rate,mean arterial pressure in C group were significantly lower than that of group A and group B(p<0.05),group A and group B with no statistical significance.(P<0.05).At T4 moment,pulse oxygen saturation in C group were significantly lower than that of group A and group B(p<0.05)in group A and group B with no statistical significance.(P<0.05)4.Compared with the A group,the number of cases of application of atropine,Group C more than Group A?B(p<0.05),Group A and group B no difference.The dosage of propofol,and additional number of lidocaine Group C?B were lower than A,the There was no statistically significant difference between Group C and B.5.Compared with Group A,body movement score Group C?B were lower than A,there was no statistically significant difference between Group C and B.no intraoperative awareness Occur,Group A have a case occur aryngospasm.Conclusion In fiber bronchoscope diagnosis and treatment,under the Narcotrend anesthesia depth monitoring,with 6ng/ml target plasma concentration of remifentanil combined with Propofol can reduce respiratory and hemodynamic fluctuations,with a lower incidence of body movement and laryngospasms during bronchoscopy,it is a safe and effective anesthesia method. |
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