de Boer Geertje M, Türk Yasemin, Meuleman-van Waning Virginie H, Braunstahl Gert-Jan
*Erasmus Medical Centre †Department of Respiratory Diseases, Franciscus Gasthuis, Rotterdam, The Netherlands.
J Bronchology Interv Pulmonol. 2017 Apr;24(2):125-130. doi: 10.1097/LBR.0000000000000356.
Flexible bronchoscopy is a frequently used procedure for the diagnosis and treatment of various lung disorders. As there is no standardized guideline on the insertion of the bronchoscope, and few studies are available on the subject, we conducted a prospective randomized controlled trial to compare nasal and oral insertion.
In total, 66 patients who underwent bronchoscopy without sedation were randomly assigned to either oral or nasal insertion. Primary and secondary outcome parameters were time to pass the vocal chords (VC) from first insertion and willingness to return (WTR).
Time to pass the VC was significantly shorter with oral insertion compared with nasal insertion (median 24.43 vs. 52.33 s; P<0.001). WTR did not differ between the 2 groups [median score 4 (nasal) vs. 5 (oral); P=0.358 on a 10-point scale]. However, a significant correlation was found between WTR and the patients' experience with the insertion of the bronchoscope in both groups (r=0.639; P=<0.001). This correlation was strongest in the nasal group (r=0.809; P=<0.001). Conversion occurred more often in the nasal group than in the oral group (51.6% vs. 1.5%).
Time to pass the VC is shorter in oral insertion compared with that in nasal insertion. In particular, after nasal insertion, a negative experience of the patient was associated with a lower score on WTR. Therefore, we advise oral insertion for a nonsedated bronchoscopy with a >6.0-mm bronchoscope when there is no indication for inspection of the upper airways.
可弯曲支气管镜检查是诊断和治疗各种肺部疾病的常用方法。由于目前尚无关于支气管镜插入的标准化指南，且该主题的研究较少，我们进行了一项前瞻性随机对照试验，以比较经鼻插入和经口插入。
总共66例未使用镇静剂进行支气管镜检查的患者被随机分配经口插入或经鼻插入。主要和次要结局参数为首次插入至通过声门（VC）的时间以及再次接受检查的意愿（WTR）。
与经鼻插入相比，经口插入通过VC的时间明显更短（中位数24.43秒对52.33秒；P<0.001）。两组之间的WTR没有差异[中位数评分4（经鼻）对5（经口）；10分制下P=0.358]。然而，两组中WTR与患者支气管镜插入体验之间均存在显著相关性（r=0.639；P<0.001）。这种相关性在经鼻组中最强（r=0.809；P<0.001）。经鼻组的转换发生率高于经口组（51.6%对1.5%）。
与经鼻插入相比，经口插入通过VC的时间更短。特别是经鼻插入后，患者的负面体验与WTR得分较低相关。因此，当无上呼吸道检查指征时，我们建议使用直径>6.0mm的支气管镜在未镇静的情况下经口插入。
