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中度镇静下经支气管内超声引导针吸活检术(CP-EBUS-TBNA)和经支气管内超声引导肺活检术(RP-EBUS-TBLB)的诊断率及安全性:单中心回顾性审计

Diagnostic Yield and Safety of CP-EBUS-TBNA and RP-EBUS-TBLB under Moderate Sedation: A Single-Center Retrospective Audit.

作者信息

Lim Valencia, Chin Reon Yew Zhou, Kee Adrian, Ng Jeffrey, See Kay Choong

机构信息

Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore 119228, Singapore.

Department of Medicine, Yong Loo Lin School of Medicine, National University Singapore, 10 Medicine Drive, Singapore 117597, Singapore.

出版信息

Diagnostics (Basel). 2022 Oct 24;12(11):2576. doi: 10.3390/diagnostics12112576.

Abstract

Convex probe endobronchial ultrasound transbronchial needle aspirations (CP-EBUS-TBNAs) and radial probe endobronchial ultrasound transbronchial lung biopsies (RP-EBUS-TBLBs) can be performed under moderate sedation or general anesthesia. Moderate sedation is more convenient, however patient discomfort may result in inadequate tissue sampling. General anesthesia ensures better patient cooperation but requires more logistics and also carries sedation risks. We aim to describe the diagnostic yield and safety of CP-EBUS-TBNAs and RP-EBUS-TBLBs when performed under moderate sedation at our center. All patients who underwent CP-EBUS-TBNA and/or RP-EBUS-TBLB under moderate sedation, between January 2015 and May 2017, were reviewed. Primary outcomes were defined in regard to the diagnostic yield and safety profile. A total of 336 CP-EBUS-TBNAs and 190 RP-EBUS-TBLBs were performed between January 2015 and May 2017. The mean sedation doses used were 50 mcg of intravenous fentanyl and 2.5 mg of intravenous midazolam. The diagnostic yield of the CP-EBUS-TBNAs and RP-EBUS-TBLBs were 62.5% and 71.6%, respectively. Complication rates were low with: transient bleeding 11.9%, transient hypoxia 0.5%, and pneumothorax 0.1%. None required escalation of care, post procedure. Performing CP-EBUS-TBNAs and RP-EBUS-TBLBs under moderate sedation is safe and provides good diagnostic yield. These procedures should, therefore, be considered as first-line sampling techniques.

摘要

凸阵探头支气管内超声引导下经支气管针吸活检术(CP-EBUS-TBNA)和径向探头支气管内超声引导下经支气管肺活检术(RP-EBUS-TBLB)可在中度镇静或全身麻醉下进行。中度镇静更方便,但患者不适可能导致组织采样不足。全身麻醉可确保患者更好地配合,但需要更多的后勤保障,且存在镇静风险。我们旨在描述在本中心中度镇静下进行CP-EBUS-TBNA和RP-EBUS-TBLB的诊断率和安全性。回顾了2015年1月至2017年5月期间在中度镇静下接受CP-EBUS-TBNA和/或RP-EBUS-TBLB的所有患者。主要结局根据诊断率和安全性进行定义。2015年1月至2017年5月期间共进行了336例CP-EBUS-TBNA和190例RP-EBUS-TBLB。使用的平均镇静剂量为静脉注射芬太尼50微克和静脉注射咪达唑仑2.5毫克。CP-EBUS-TBNA和RP-EBUS-TBLB的诊断率分别为62.5%和71.6%。并发症发生率较低,短暂出血为11.9%,短暂低氧血症为0.5%,气胸为0.1%。术后均无需加强护理。在中度镇静下进行CP-EBUS-TBNA和RP-EBUS-TBLB是安全的,且诊断率良好。因此,这些操作应被视为一线采样技术。

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