姿势对支气管镜检查期间患者的咳嗽频率、镇静剂需求及舒适度的影响：一项观察性队列研究。

Posture influences patient cough rate, sedative requirement and comfort during bronchoscopy: An observational cohort study.

作者信息

Ling Ivan T, Piccolo Francesco, Mulrennan Siobhain A, Phillips Martin J

机构信息

Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.

出版信息

Cough. 2011 Nov 10;7:9. doi: 10.1186/1745-9974-7-9.

DOI:10.1186/1745-9974-7-9

PMID:22074355

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3226548/

Abstract

OBJECTIVES

To investigate differences between semi-recumbent and supine postures in terms of cough rate, oxygen desaturation, sedative use, and patient comfort during the initial phase of bronchoscopy.

METHODS

Consecutive bronchoscopy patients (n = 69) participated in this observational cohort study. Posture was determined by the bronchoscopist's usual practice. Patient demographics, spirometry, pulse, and SpO2 were recorded. The initial phase was defined as the time from bronchoscopy insertion to visualisation of both distal main bronchi. Cough rate, peak pulse, nadir SpO2, oxygen supplementation, and sedative use during the initial phase were recorded. A post-procedure questionnaire was administered to the patient and the attending nurse.

RESULTS

36 patients had bronchoscopy in the semi-recumbent posture, 33 in the supine posture. 3 of 5 bronchoscopists performed in both postures. There were no differences in baseline parameters between the groups. The semi-recumbent posture resulted in significantly less cough (mean (SD) 3.6 (2.3) vs. 6.1 (4.5) coughs/min, p = 0.007) and less fentanyl use (70 (29) vs. 88 (28) mcg, p = 0.011) in the initial phase. There were no significant differences in the nadir SpO2, fall in SpO2, oxygen supplementation, or increase in pulse rate between the groups. On 100 mm visual analogue scale, nurse perception of patient discomfort was lower in the semi-recumbent position (23 (21) vs. 39 (28) mm, p = 0.01), and there was a trend towards less patient perceived cough in the semi-recumbent group (28 (25) vs. 40 (28) mm, p = 0.06).

CONCLUSIONS

Bronchoscopy performed in the semi-recumbent posture results in less cough and sedative requirement, and may improve patient comfort.

摘要

目的

探讨在支气管镜检查初始阶段，半卧位与仰卧位在咳嗽频率、氧饱和度下降、镇静剂使用及患者舒适度方面的差异。

方法

连续的支气管镜检查患者（n = 69）参与了这项观察性队列研究。体位由支气管镜检查医师的常规操作决定。记录患者的人口统计学资料、肺功能、脉搏和血氧饱和度。初始阶段定义为从支气管镜插入到观察到双侧主支气管远端的时间。记录初始阶段的咳嗽频率、脉搏峰值、最低血氧饱和度、吸氧情况和镇静剂使用情况。术后向患者及护理人员发放问卷。

结果

36例患者采用半卧位进行支气管镜检查，33例采用仰卧位。5名支气管镜检查医师中有3名在两种体位下均进行了操作。两组间基线参数无差异。半卧位在初始阶段导致咳嗽明显减少（平均（标准差）3.6（2.3）次/分钟 vs. 6.1（4.5）次/分钟，p = 0.007），芬太尼使用量减少（70（29）μg vs. 88（28）μg，p = 0.011）。两组间最低血氧饱和度、血氧饱和度下降幅度、吸氧情况或脉搏率增加无显著差异。在100mm视觉模拟量表上，护理人员对患者不适的感知在半卧位时较低（23（21）mm vs. 39（28）mm，p = 0.01），半卧位组患者自我感觉咳嗽也有减少趋势（28（25）mm vs. 40（28）mm，p = 0.06）。