Yuan Y, Zhang J, Yue H L, Wang J, Pei Y H, Qiu X J, Wang Y L, Wang T
Department of Respiratory, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China.
Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2019 Feb 12;42(2):106-113. doi: 10.3760/cma.j.issn.1001-0939.2019.02.006.
This study aimed to explore a feasible method of anesthesia for painless bronchoscopy. A total of 120 patients receiving flexible bronchoscopy in Beijing Tiantan Hospital during the period from February, 8, 2018 to May, 4, 2018, were randomly divided into 3 groups, including group A (using lidocaine for local anesthesia), group B (using lidocaine + midazolam + fentanyl), and group C (using lidocaine + propofol + sufentanil). There were 41 patients in group A, 38 in group B and 41 in group C. The changes in systolic blood pressure, diastolic blood pressure, heart rate and pulse oxygen saturation(SpO(2)) in each group were recorded in different points of time. The safety of different methods of anesthesia was observed by recording vital signs and adverse events. Moreover, the visual analogue scale (VAS) was used to observe the patient's tolerance and satisfaction of the operation. The intraoperative systolic blood pressure and diastolic blood pressure in group C were significantly lower than those in group A and B (0.05). Six cases in group C had hypotension, 3 of whom required vasoactive drugs. The differences of SpO(2) between the 3 groups showed no statistical significance (0.05), while patients in group C were prone to decrease in SpO(2). Eighteen patients in group C had hypoxemia during operation. But after treated with improving ventilation, the SpO(2) of those patients could be restored to normal. Compared with those in group C, patients in group A and group B showed significant discomfort, cough, and more pharyngeal pain (0.05). However, there were no significant differences in the degree of cough and pain between group A and group B (0.05). Most patients in group C had no uncomfortable sensation during the operation (0.05), and the willingness to re-examination was significantly higher than that in group A and group B (0.05). Propofol combined with sufentanil could achieve better painless effect, improve patient comfort and tolerance, and reduce intraoperative memory, but was prone to causing hypoxemia and hypotension. The decline of intraoperative SpO(2) could be corrected by establishing artificial airway, while the decrease of blood pressure could be corrected by applying vasoactive drugs, which were relatively safe.
本研究旨在探索一种可行的无痛支气管镜麻醉方法。2018年2月8日至2018年5月4日期间在北京天坛医院接受柔性支气管镜检查的120例患者被随机分为3组，包括A组（使用利多卡因进行局部麻醉）、B组（使用利多卡因+咪达唑仑+芬太尼）和C组（使用利多卡因+丙泊酚+舒芬太尼）。A组有41例患者，B组有38例，C组有41例。记录每组在不同时间点收缩压、舒张压、心率和脉搏血氧饱和度（SpO₂）的变化。通过记录生命体征和不良事件观察不同麻醉方法的安全性。此外，使用视觉模拟评分法（VAS）观察患者对手术的耐受性和满意度。C组术中收缩压和舒张压显著低于A组和B组（P<0.05）。C组有6例出现低血压，其中3例需要使用血管活性药物。3组之间SpO₂的差异无统计学意义（P>0.05），但C组患者SpO₂容易下降。C组有18例患者在手术中出现低氧血症。但经改善通气治疗后，这些患者的SpO₂可恢复正常。与C组相比，A组和B组患者表现出明显的不适、咳嗽，且咽痛更明显（P<0.05）。然而，A组和B组之间咳嗽和疼痛程度无显著差异（P>0.05）。C组大多数患者在手术过程中无不适感（P<0.05），且再次检查的意愿显著高于A组和B组（P<0.05）。丙泊酚联合舒芬太尼可获得较好的无痛效果，提高患者舒适度和耐受性，并减少术中记忆，但容易引起低氧血症和低血压。术中SpO₂下降可通过建立人工气道纠正，而血压下降可通过应用血管活性药物纠正，相对安全。
