Konrad F, Deller A, Diatzko J, Schmitz J E, Kilian J
Universitätsklinik für Anaesthesiologie, Klinikum der Universität Ulm.
Anaesthesist. 1989 Apr;38(4):174-9.
Flexible fiberoptic bronchoscopy of intubated patients can be performed in general or local anesthesia (LA). Up to now, no results have been published on the effects of LA for bronchoscopy in ventilated patients. We studied the hemodynamic changes caused by bronchoscopy under LA in mechanically ventilated patients and the effect of LA on the endoscopic decline in arterial pO2. Differences between the widely used agents lidocaine and oxybuprocaine hydrochloride were also studied. We found a decline in paO2 after the administration of LA and further investigated the influence of bronchial lavage on paO2. METHOD. A total of 70 ventilator patients, excluding patients with atelectasis, massive mucous-plug retention, and those under muscle relaxants, were examined in a surgical intensive care unit. In 40 long-term ventilator patients bronchoscopy was performed with either oxybuprocaine hydrochloride 1% (Novesin) (group 1; n = 20) or Lidocaine 1% (Xylocaine) (group 2; n = 20) (2-3 ml LA in repeated doses into the trachea and main bronchi; total amount 10 ml). We looked for hemodynamic changes and effects of LA on the bronchoscopic decline in paO2. In 15 long-term ventilator patients (group 3), LA was applied without bronchoscopy to investigate the duration of the LA-caused decline in paO2. In 15 intubated patients (group 4), the influence of intratracheal administration of 10 ml normal saline was examined. Patient data are shown in Table 2. Measurements were performed in groups 1 and 2 before and after LA, immediately after bronchoscopy and 15, 30, and 60 min after bronchoscopy and in groups 3 and 4 before and 5, 15, 30, and 60 min after LA. RESULTS. There was no effect on cardiocirculatory function during bronchoscopy in LA, but we found a decrease in paO2 after administration of LA in all patients (median in group 1 from 100 to 78 mmHg in group 2 from 104 to 86 mmHg). The subsequent bronchoscopy caused only a small, nonsignificant further decline in paO2. The administration of LA without bronchoscopy (group 3) was followed by a fall in paO2 from 86 +/- 12.5 to 69 +/- 11.7 mmHg (mean +/- SD) with oxybuprocaine hydrochloride and from 87 +/- 12.4 to 72 +/- 8.7 mmHg with lidocaine. Even after 30 min the paO2 had not returned to the initial value. The intratracheal application of 10 ml 0.9% NaCl caused a decline in paO2 from 101 +/- 20 to 78 +/- 12 mmHg (mean +/- SD), which also persisted for more than 30 min. CONCLUSIONS. The study shows that in ventilator patients undergoing fiberoptic bronchoscopy in LA, the administration of the LA is an essential factor in the decline in paO2 associated with bronchoscopy. A similar fall in paO2 is observed by intratracheal
对于已插管患者，可在全身麻醉或局部麻醉（LA）下进行可弯曲纤维支气管镜检查。到目前为止，尚未有关于局部麻醉用于机械通气患者支气管镜检查效果的研究结果发表。我们研究了在局部麻醉下支气管镜检查对机械通气患者血流动力学的影响，以及局部麻醉对动脉血氧分压（pO₂）内镜检查时下降的影响。同时也研究了广泛使用的药物利多卡因和盐酸奥布卡因之间的差异。我们发现局部麻醉给药后动脉血氧分压（paO₂）下降，并进一步研究了支气管灌洗对paO₂的影响。方法：在外科重症监护病房对70例机械通气患者进行检查，排除肺不张、大量黏液栓滞留患者以及使用肌肉松弛剂的患者。在40例长期机械通气患者中，使用1%盐酸奥布卡因（诺维辛）（第1组；n = 20）或1%利多卡因（赛罗卡因）（第2组；n = 20）进行支气管镜检查（将2 - 3 ml局部麻醉药分多次注入气管和主支气管；总量10 ml）。我们观察血流动力学变化以及局部麻醉对支气管镜检查时paO₂下降的影响。在15例长期机械通气患者（第3组）中，不进行支气管镜检查而应用局部麻醉药，以研究局部麻醉药导致的paO₂下降持续时间。在15例已插管患者（第4组）中，检查气管内注入10 ml生理盐水的影响。患者数据见表2。在第1组和第2组中，于局部麻醉前、局部麻醉后、支气管镜检查后即刻以及支气管镜检查后15、30和60分钟进行测量；在第3组和第4组中，于局部麻醉前以及局部麻醉后5、15、30和60分钟进行测量。结果：局部麻醉下支气管镜检查期间对心脏循环功能无影响，但我们发现所有患者局部麻醉给药后paO₂均下降（第1组中位数从100 mmHg降至78 mmHg，第2组从104 mmHg降至86 mmHg）。随后的支气管镜检查仅导致paO₂进一步小幅下降，且无显著意义。未进行支气管镜检查而应用局部麻醉药（第3组）后，使用盐酸奥布卡因时paO₂从86±12.5 mmHg降至69±11.7 mmHg（均值±标准差），使用利多卡因时从87±12.4 mmHg降至72±8.7 mmHg。即使在30分钟后，paO₂仍未恢复至初始值。气管内注入10 ml 0.9%氯化钠溶液导致paO₂从101±20 mmHg降至78±12 mmHg（均值±标准差），且这种下降也持续超过30分钟。结论：该研究表明，对于在局部麻醉下接受纤维支气管镜检查的机械通气患者，局部麻醉药的给药是与支气管镜检查相关的paO₂下降的一个重要因素。气管内注入生理盐水也观察到类似的paO₂下降情况。
