Lang Jie, Guo Zhi-Zhen, Xing Shu-Shan, Sun Jian, Qiu Bin, Shu Yu, Wang Zhi-Qiang, Liu Gui-Xiang
Department of Thoracic Surgery, Tangshan People's Hospital, Tangshan 063000, Hebei Province, China.
Department of Nephrology, Kailuan General Hospital, Tangshan 063000, Hebei Province, China.
World J Clin Cases. 2023 Jul 26;11(21):5108-5114. doi: 10.12998/wjcc.v11.i21.5108.
Fibrobronchoscopy is a common adjunct tool that requires anesthesia and is widely used in the diagnosis and treatment of various respiratory diseases. However, current anesthesia methods, such as spray, nebulized inhalation, and cricothyroid membrane puncture, have their own advantages and disadvantages. Recently, studies have shown that bronchoscopic direct-view glottis anesthesia is a simple and inexpensive method that shortens the examination time and provides excellent anesthetic results.
To evaluate the effectiveness of bronchoscopic direct vision glottis anesthesia for bronchoscopy.
The study included 100 patients who underwent bronchoscopy during thoracic surgery. A random number table method was used to divide the patients into control and observation groups (50 patients each). The control and observation groups were anesthetized using the nebulized inhalation and bronchoscopic direct vision glottis method, respectively. Hemodynamic indices [systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and oxygen saturation (SpO) before (T1), 5 min after anesthesia (T2), and at the end of the operation (T3)] serum stress hormone indices [norepinephrine (NE), epinephrine (E), adrenocorticotropic hormone (ACTH), and cortisol (Cor) before and after treatment] were compared between the 2 groups. Adverse effects were also compared between the two groups.
At T2 and T3, SBP, DBP, and HR were lower in the observation group than the control group, whereas SpO was higher than the control group [(119.05 ± 8.01) mmHg (127.05 ± 7.83) mmHg, (119.35 ± 6.66) mmHg (128.39 ± 6.56) mmHg, (84.68 ± 6.04) mmHg (92.42 ± 5.57) mmHg, (84.53 ± 4.97) mmHg compared to (92.57 ± 6.02) mmHg, (74.25 ± 5.18) beats/min compared to (88.32 ± 5.72) beats/min, (74.38 ± 5.31) beats/min compared to (88.42 ± 5.69) beats/min, (97.36 ± 2.21)% (94.35 ± 2.16)%, (97.42 ± 2.36)% (94.38 ± 2.69%], with statistically significant differences (all < 0.05). After treatment, NE, E, ACTH, and Cor were significantly higher in both groups than before treatment, but were lower in the observation group than in the control group [(68.25 ± 8.87) ng/mL (93.35 ± 14.00) ng/mL, (53.59 ± 5.89) ng/mL (82.32 ± 10.70) ng/mL, (14.32 ± 1.58) pg/mL (20.35 ± 3.05) pg/mL, (227.35 ± 25.01) nmol/L (322.28 ± 45.12) nmol/L], with statistically significant differences (all < 0.05). The incidence of adverse reactions was higher in the control group than in the observation group [12.00% (12/50) 6.00% (3/50)] ( < 0.05).
The use of bronchoscopic direct vision glottis anesthesia method for bronchoscopy patients is beneficial for stabilizing hemodynamic indices during bronchoscopy and reducing the level of patient stress, with good safety and practicality.
纤维支气管镜检查是一种常用的辅助工具，需要麻醉，广泛应用于各种呼吸系统疾病的诊断和治疗。然而，目前的麻醉方法，如喷雾、雾化吸入和环甲膜穿刺，都有各自的优缺点。最近的研究表明，支气管镜直视声门麻醉是一种简单且成本低廉的方法，可缩短检查时间并提供出色的麻醉效果。
评估支气管镜直视声门麻醉用于支气管镜检查的有效性。
该研究纳入了100例在胸外科手术期间接受支气管镜检查的患者。采用随机数字表法将患者分为对照组和观察组（每组50例）。对照组和观察组分别采用雾化吸入和支气管镜直视声门法进行麻醉。比较两组患者的血流动力学指标[麻醉前（T1）、麻醉后5分钟（T2）和手术结束时（T3）的收缩压（SBP）、舒张压（DBP）、心率（HR）和血氧饱和度（SpO）]、血清应激激素指标[治疗前后的去甲肾上腺素（NE）、肾上腺素（E）、促肾上腺皮质激素（ACTH）和皮质醇（Cor）]。同时比较两组的不良反应情况。
在T2和T3时，观察组的SBP、DBP和HR低于对照组，而SpO高于对照组[（119.05±8.01）mmHg比（127.05±7.83）mmHg，（119.35±6.66）mmHg比（128.39±6.56）mmHg，（84.68±6.04）mmHg比（92.42±5.57）mmHg，（84.53±4.97）mmHg比（92.57±6.02）mmHg，（74.25±5.18）次/分比（88.32±5.72）次/分，（74.38±5.31）次/分比（88.42±5.69）次/分，（97.36±2.21）%比（94.35±2.16）%，（97.42±2.36）%比（94.38±2.69）%]，差异有统计学意义（均P<0.05）。治疗后，两组患者的NE、E、ACTH和Cor均显著高于治疗前，但观察组低于对照组[（68.25±8.87）ng/mL比（93.35±14.00）ng/mL，（53.59±5.89）ng/mL比（82.32±10.70）ng/mL，（14.32±1.58）pg/mL比（20.35±3.05）pg/mL，（227.35±25.01）nmol/L比（322.28±45.12）nmol/L]，差异有统计学意义（均P<0.05）。对照组的不良反应发生率高于观察组[12.00%（12/50）比6.00%（3/50）]（P<0.05）。
对支气管镜检查患者采用支气管镜直视声门麻醉方法，有利于稳定支气管镜检查期间的血流动力学指标，降低患者应激水平，安全性及实用性良好。
