术前使用肾上腺素和利多卡因进行鼻探针测试可减轻纤维支气管镜检查时的插入难度，并减少术后出血：一项随机对照试验。

Pre-operative nasal probe tests with adrenaline and lidocaine ease insertion during flexible bronchoscopy and reduce post-operative bleeding: a randomized controlled trial.

机构信息

Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.

Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.

出版信息

Chin Med J (Engl). 2022 Aug 5;135(15):1808-1813. doi: 10.1097/CM9.0000000000002006.

DOI:10.1097/CM9.0000000000002006

PMID:35838535

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9521767/

Abstract

BACKGROUND

Nasal insertion is the preferred method for non-intubated patients in flexible bronchoscopy; however, the relatively narrow nasal cavity results in difficulties related to bronchoscope insertion. This study aimed to investigate whether pre-operative nasal probe tests could reduce the time to pass the glottis, improve the first-pass success rate and patients' tolerance, and reduce postoperative bleeding.

METHODS

This three-arm prospective randomized controlled trial was conducted in a tertiary hospital between May and October 2020. Three hundred patients requiring diagnosis and treatment using flexible bronchoscopy were randomly allocated to three groups: control group, simple cotton bud detection group (CD group), and adrenaline + lidocaine detection group (AD group). The primary outcome was the time to pass the glottis. Secondary outcomes included the first-pass success rate, the patients' tolerance scores, and post-operative bleeding. One-way analysis of variance, Kruskal-Wallis H test, Chi-squared test, Fisher's exact test, and Bonferroni's multiple comparison tests were used in this study.

RESULTS

In total, 189 men and 111 women were enrolled in this study, with a mean age of 55.72 ± 12.86 years. The insertion time was significantly shorter in the AD group than in the control group (18.00 s [12.00-26.50 s] vs . 24.00 s [14.50-45.50 s], P = 0.005). Both the AD (99% vs . 83%, χ2 = 15.62, P < 0.001) and CD groups (94% vs . 83%, χ2 = 5.94, P = 0.015) had a significantly higher first-pass success rate than the control group. Compared with the control group, post-operative bleeding (1% vs . 13%, χ2 = 11.06, P < 0.001) was significantly lower in the AD group. However, no significant difference was found in the patients' tolerance scores.

CONCLUSIONS

Pre-operative nasal cavity probe tests especially with adrenaline and lidocaine during flexible bronchoscopy can significantly reduce the time to pass the glottis, improve the first-pass success rate, and reduce post-operative nasal bleeding. Pre-operative nasal probe tests are recommended as a time-saving procedure for patients undergoing flexible bronchoscopy.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (ChiCTR), ChiCTR2000032668; http://www.chictr.org.cn/showprojen.aspx?proj=53321 .

摘要

背景

经鼻插入是无插管患者行软性支气管镜检查的首选方法；然而，相对狭窄的鼻腔会导致支气管镜插入困难。本研究旨在探讨术前鼻探针检查是否能减少通过声门的时间，提高首次通过成功率和患者耐受性，并减少术后出血。

方法

这是一项于 2020 年 5 月至 10 月在一家三级医院进行的三臂前瞻性随机对照试验。将 300 名需要通过软性支气管镜进行诊断和治疗的患者随机分为三组：对照组、单纯棉拭子检测组（CD 组）和肾上腺素+利多卡因检测组（AD 组）。主要结局是通过声门的时间。次要结局包括首次通过成功率、患者耐受性评分和术后出血。本研究采用单因素方差分析、Kruskal-Wallis H 检验、卡方检验、Fisher 确切检验和 Bonferroni 多重比较检验。

结果

共纳入 189 名男性和 111 名女性患者，平均年龄为 55.72±12.86 岁。AD 组的插入时间明显短于对照组（18.00 s [12.00-26.50 s] 比 24.00 s [14.50-45.50 s]，P=0.005）。AD 组（99%比 83%，χ2=15.62，P<0.001）和 CD 组（94%比 83%，χ2=5.94，P=0.015）的首次通过成功率均明显高于对照组。与对照组相比，AD 组术后出血（1%比 13%，χ2=11.06，P<0.001）明显减少。然而，患者的耐受评分无显著差异。