Application of dexmedetomidine combined with propofol and remifentanil in fiberbronchoscopy in elderly patients with chronic obstructive pulmonary disease / 中国基层医药

ABSTRACT

Objective:To investigate the application effect of dexmedetomidine combined with propofol and remifentanil in fiberoptic bronchoscopy in elderly patients with chronic obstructive pulmonary disease(COPD).Methods:From October 2018 to November 2019, 112 elderly patients with COPD who were examined by fiberoptic bronchoscopy in the Affiliated Hospital of Medical College of Ningbo University were divided into control group and observation group, with 56 cases in each group.Propofol and remifentanil were used for anesthesia induction in both two groups.Dexmedetomidine (0.5μg/kg) was injected intravenously into observation group, and later 0.5μg·kg -1·h -1 continuous infusion, the control group was given the same dose of 0.9% sodium chloride injection.The OAA/S scores, propofol dosage, remifentanil dosage, wake-up time, heart rate, oxygen saturation, mean arterial pressure, pulmonary function changes and adverse reactions were compared between the two groups. Results:At the fiberbronchoscope entered immediately and 10 min after examination, the OAA/S scores in the observation group were (1.03±0.35)points, (4.42±0.28)points, respectively, which in the control group were (1.22±0.22)points, (3.01±0.22)points, respectively, the differences between the two groups were statistically significant( t=3.439, 29.631, all P<0.05). The dosages of propofol and remifentanil in the observation group were (3.00±0.28)μg/kg and (1.65±0.29)μg/kg, respectively, which were less than those in the control group [(3.70±0.39)μg/kg, (2.42±0.45)μg/kg], the recovery time was (8.40±1.58)min, which was shorter than that in the control group [(13.31±2.02)min], the differences were statistically significant( t=10.911, 10.763, 14.327, all P<0.05). The heart rate, oxygen saturation, mean arterial pressure, pulmonary function(FEV 1, MVV) in the observation group were significantly better than those in the control group( t=9.757, 11.981, 11.486, 11.913, 40.189, all P<0.05). The incidence of adverse reactions in the observation group was 7.14%(4/56), which was lower than 19.64%(11/56) in the control group(χ 2=6.737, P<0.05). Conclusion:Dexmedetomidine(0.5μg/kg, followed by 0.5μg·kg -1·h -1 continuous infusion) and target controlled infusion of propofol and remifentanil are safe for elderly patients with COPD, and the use of anesthetic drugs is small, which can shorten the recovery time after operation, and will not have a great impact on respiratory circulation.