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J Bronchology Interv Pulmonol:评估氯胺酮用于成人支气管镜检查的前瞻性随机对照试验

2017-11-14 佘玉琦 “罂粟花”微信号

氯胺酮可用于小儿纤维支气管镜检查,但氯胺酮对于接受纤维支气管镜检查的成人进行镇静的有效性和安全性尚未研究,因此大多数介入性支气管镜检查并未使用氯胺酮。本研究的目的是评估氯胺酮-丙泊酚-咪达唑仑与芬太尼-丙泊酚-咪达唑仑方案镇静相比之下,行纤维支气管镜检查的有效性和安全性。

背景与目的:氯胺酮可用于小儿纤维支气管镜检查,但氯胺酮对于接受纤维支气管镜检查的成人进行镇静的有效性和安全性尚未研究,因此大多数介入性支气管镜检查并未使用氯胺酮。本研究的目的是评估氯胺酮-丙泊酚-咪达唑仑与芬太尼-丙泊酚-咪达唑仑方案镇静相比之下,行纤维支气管镜检查的有效性和安全性。

方  法:这是一项前瞻性随机对照试验,成年患者(n = 80)接受纤维支气管镜检查,随机分为接受氯胺酮-丙泊酚-咪达唑仑(n = 39)或芬太尼-丙泊酚-咪达唑仑(n = 41)镇静。包括持续监测经皮二氧化碳分压。比较镇静相关并发症和维持呼吸和血流动力学稳定性的干预措施。手术者和患者对使用的镇静方案不知情。手术者和患者对镇静的满意度在恢复后进行了评估。

结  果:氯胺酮-丙泊酚-咪达唑仑和芬太尼-丙泊酚-咪达唑仑组最大胸腔内经皮二氧化碳分压值(63.2±11.4mmHg vs.61.1±7.2mmHg)和最小氧饱和度(77.1%±12.5%vs.81.8%±12.0%)组间差异无统计学意义。氯胺酮-丙泊酚-咪达唑仑与芬太尼-丙泊酚-咪达唑仑组在镇静相关的呼吸或血液动力学并发症方面没有显着差异。手术者和患者对镇静的满意度组间相似。

结  论:对于纤维支气管镜检查的成人进行镇痛和镇静,氯胺酮与芬太尼一样安全有效。鉴于这一观察结果,氯胺酮与大多数镇静剂一样不引起血流动力学抑制,而且是一种有效的支气管扩张剂,应鼓励其更广泛的用于成人纤维支气管镜检查的镇静。

原始出处:

Fruchter O,et al.,Prospective Randomized Trial Evaluating Ketamine for Adult Bronchoscopy.J Bronchology Interv Pulmonol. 2017 Oct;24(4):279-284.

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    2018-06-30 amyloid
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    2017-11-16 jml2009
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