| Objectives:The purpose of this study was to explore the application effect of sedation and analgesia of midazolam combined with sufentanil in elderly patients undergoing medical thoracoscopy assisted local anesthesia,and to evaluate the changes of vital signs of sedation and analgesia,adverse reactions during and after surgery and postoperative safety and comfort,which could provide clinical evidences for actively applying midazolam combined with sufentanil to assisting sedation and analgesia in elderly patients undergoing medical thoracoscopy.Methods:In this study,elderly patients with exudative pleural effusion who underwent medical thoracoscopy in the Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Chengdu Medical College from 2017 to 2022 were collected,and147 elderly patients underwent medical thoracoscopy were finally included through inclusion and exclusion criteria.Grouping methods: 75 patients with simple local anesthesia were classified as group A,and 72 patients who had local anesthesia combined midazolam with sufentanil for sedation and analgesia were regarded as group B.We had collected the basic clinical information in both groups,such as age,gender and chronic diseases.And heart rate(HR),respiratory rate(RR),mean arterial pressure(MAP),percutaneous oxygen saturation(Sp O2),VAS score,OAA/S score,postoperative adverse reactions,pain,analgesia requirements,and doctor satisfaction score were also recorded.Results:1.The study finally included 147 elderly patients,including 93 male patients and 54 female patients;there was no statistical difference in age,sex,height,weight,combined underlying diseases and fluid volume of pleural effusion range in the two groups.2.In this study,compared with group B,the values of HR,RR and MAP in group A were significantly higher than those before surgery,the time of taking the biopsy and at the end of surgery(p< 0.05).At 2 h,12 h and 24 h after surgery,HR,RR and MAP in group A significantly decreased(p<0.05).There were no significant changes in Sp O2 in both group A and group B at each time point during the whole procedure.3.Before surgery,at biopsy,at the end of surgery and 2 hours after operation,the pain’s VAS scores of group B were highly lower than those in group A(p<0.05).For the patients of group A,pain’s VAS scores at 2,12,and 24 hours after surgery were lower than those before surgery,at biopsy,and at the end of surgery(p<0.05).4.There were 57 patients in group A and 44 patients in group B who complained of pain after surgery.And the difference between the two groups was statistically significant(p<0.05).Postoperative analgesia was required in 38 patients in group A and 16 patients in group B,and there were the statistical differences(p=0.006).5.Postoperative subcutaneous emphysema and fever were found in both group A and group B.The number of patients with postoperative subcutaneous emphysema was 5in group A and 3 in group B,but the results were not statistically different(p<0.05).Fever occurred in 7 patients in group A and 8 patients in group B,and there was also no statistical difference(p<0.05).And there were no postoperative complications such as pulmonary edema,air leakage,thoracic hemorrhage and infection in both groups after surgery.6.For the patients undergoing medical thoracoscopy treated with local anesthesia combined midazolam with sufentanil,the values of OAA/S score before administration were lower than those before surgery,at biopsy and at the end of operation(p<0.05).7.In this study,group B was significantly more satisfied than group A(p<0.05).Conclusions:The results of this study show that midazolam and sufentanil are proved to be a safe and effective method of internal thoracoscopy assisted sedation and analgesia in elderly patients.Good postoperative comfort can reduce the pain of elderly patients,but it has no effect on postoperative complications except pain,and doctor-patient satisfaction is high,so it can be applied to clinical practice. |
