目的 觀察丙泊酚與依托咪酯乳劑在顱腦損傷合并肺部感染患者纖維支氣管鏡治療中的鎮(zhèn)靜效果及安全性。方法 選取河北醫(yī)科大學(xué)第二醫(yī)院2019年1月一2021年8月收治的重癥醫(yī)學(xué)科（ICU）機(jī)械通氣顱腦損傷合并肺部感染患者84例為研究對(duì)象，按照用藥方案不同分為丙泊酚組和依托咪酯組，每組各42例。兩組均給予纖維支氣管鏡治療，丙泊酚組給予丙泊酚乳狀注射液1~2 mg·kg^-1，人工緩慢靜推3~5 min。依托咪酯組給予依托咪酯中/長(zhǎng)鏈脂肪乳注射液0.2~0.4 mg·kg^-1，緩慢靜推。操作中若患者躁動(dòng)明顯或嗆咳劇烈影響進(jìn)境，或氣管壁出血，則追加丙泊酚30mg或依托咪酯6mg。比較兩組給藥前5 min （T₀）、給藥后-入鏡即刻（T₁）、入鏡后3 min （T₂）、入鏡后10 min （T₃）、撤鏡即刻（T₄）、術(shù)畢5 min （T₅）時(shí)腦電雙頻譜指數(shù)（BIS）、心率（HR）、呼吸頻率（RR）、平均動(dòng)脈壓（MAP）、血氧飽和度（SpO₂）、腦氧飽和度（rSO₂）差異，比較兩組藥物平均使用量、追加藥物次數(shù)、麻醉起效時(shí)間、不良反應(yīng)發(fā)生情況及纖維支氣管鏡操作醫(yī)生對(duì)鎮(zhèn)靜效果的滿意度。結(jié)果 T₁、T₄、T₅時(shí)兩組BIS均低于本組T₀時(shí)，T₂、T₃時(shí)高于本組T₁時(shí)（P<0.05）；T₀、T₂、T₄、T₅時(shí)兩組BIS差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）；T₁、T₃時(shí)丙泊酚組BIS低于依托咪酯組（P<0.05）；T₁、T₂、T₃、T₄時(shí)丙泊酚組HR、MAP低于依托咪酯組（P<0.05）；T₀、T₅時(shí)兩組HR、MAP差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）；T₀、T₁、T₂、T₃、T₄、T₅時(shí)兩組RR、SpO₂、rSO₂差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）；丙泊酚組藥物平均使用量多于依托咪酯組，追加藥物次數(shù)少于依托咪酯組（P<0.05）；兩組麻醉起效時(shí)間差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）；依托咪酯組嗆咳反應(yīng)發(fā)生率高于丙泊酚組（P<0.05）；兩組呼吸抑制發(fā)生率、躁動(dòng)發(fā)生率差、纖維支氣管鏡操作醫(yī)生對(duì)鎮(zhèn)靜效果滿意度差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）。結(jié)論 丙泊酚與依托咪酯乳劑在ICU機(jī)械通氣顱腦損傷合并肺部感染患者行纖維支氣管鏡治療中均具有良好鎮(zhèn)靜效果，其中依托咪酯藥物平均使用量較少，對(duì)HR、MAP、BIS影響較小，但追加藥物頻次、嗆咳反應(yīng)發(fā)生率較高。

Objective To observe the sedative effect and safety of propofol and etomidate emulsion in patients with craniocerebral brain injury combined with pulmonary infection treated by fiberoptic bronchoscopy.Methods A total of 84 patients with craniocerebral injury combined with pulmonary infection and mechanical ventilation in ICU from January 2019 to August 2021 in the Second Hospital of Hebei Medical University were selected as the research objects.They were divided into propofol group and etomidate group according to different medication schemes, with 42 patients in each group.Patients in both groups were treated with fiberoptic bronchoscope.Patients in propofol group were treated with 1-2 mg·kg^-1 of Propofol Emulsion Injection, and was given a slow artificial static push for 3-5 min.Patients in etomidate group were given 0.2-0.4 mg·kg^-1 of Etomidate Medium/Long Chain Fat Emulsion Injection, and the injection was given slowly.During the operation, if the patient's restlessness is obvious or cough severely affects the entry, or the trachea wall bleeds, 30 mg of propofol or 6 mg of etomidate were added.The differences of bispectral index(BIS), heart rate(HR), respiratory rate(RR), mean arterial pressure(MAP), blood oxygen saturation(SpO₂), cerebral oxygen saturation(rSO₂) at five minutes before administration(T₀), after administration-immediately after entering the mirror(T₁), three minutes after entering the mirror(T₂), 10 min after entering the mirror(T₃), immediately after removing the mirror(T₄), and five minutes after operation(T₅), respectively.The dosage of drugs, times of additional drugs, onset time of anesthesia, occurrence of adverse reactions and satisfaction of fiberoptic bronchoscope operators on sedation effect were compared between the two groups.Results The BIS of the two groups at T₁, T₄ and T₅ were lower than that of the group at T₀, and BIS of the two groups at T₂ and T₃ higher than that of the group at T₀(P<0.05).There was no significant difference in BIS between the two groups at T₀, T₂, T₄ and T₅(P> 0.05).At T₁ and T₃, BIS in propofol group was lower than that in etomidate group(P<0.05).HR and MAP in propofol group were lower than those in etomidate group at T₁, T₂, T₃ and T₄(P<0.05).There was no significant difference in HR and MAP between the two groups at T₀ and T₅(P> 0.05).There was no significant difference in RR, SpO₂ and rSO₂ between the two groups at T₀, T₁, T₂, T₃, T₄ and T₅(P> 0.05).The drug use amount and the number of additional drugs in etomidate group were higher than those in propofol group(P<0.05).There was no significant difference in onset time of anesthesia between the two groups(P> 0.05).The incidence of cough reaction in etomidate group was higher than that in propofol group(P<0.05).There was no significant difference between the two groups in the incidence of respiratory depression, restlessness, and the satisfaction of fiberoptic bronchoscope operators with sedation effect(P> 0.05).Conclusion Propofol and etomidate emulsion have good sedative effect in patients with mechanical ventilation craniocerebral injury combined with pulmonary infection in ICU undergoing fiberoptic bronchoscopy.The average use of etomidate is less, which has little impact on HR, MAP and BIS, but the frequency of additional drugs and the incidence of cough reaction are higher.

R971

河北省重點(diǎn)科技研究計(jì)劃項(xiàng)目（20190561）