不同麻醉方法纤维支气管镜检查的效果比较

The effect of anesthesia approaches on fiberoptic bronchoscopy

目的探讨静脉麻醉下纤维支气管镜(纤支镜)检查治疗的安全性和可行性。方法将60例行纤支镜检查的患者随机分为3组,传统经改良组(A组,20例)、基础麻醉组(B组,20例)和静脉麻醉组(C组,20例)。A组按常规在鼻咽气管表面麻醉下进行检查;B组在A组的基础上静脉滴注芬太尼1μg/kg、咪唑安定0.02mg/kg,待患者OAA/S达3分时开始操作;C组静脉滴注芬太尼1μg/kg、泵入丙泊酚10～20ml/h,待患者OAA/S达2分时开始操作。观察3组患者术前、术中及术后的血压、心率、脉搏血氧饱和度、呼吸变化、检查过程中的不良反应和术后体会。结果 A组出现不良反应较多;B组出现恶心、呛咳、憋气及体动等不良反应很少,脉搏血氧饱和度、血压、心率和呼吸频率变化不明显;C组能在无知觉和无痛苦中接受检查。结论采用静脉基础和静脉全身麻醉行纤支镜检查安全可行,患者痛苦小,检查成功率高。

Objective To study the safety and feasibility of fiberoptic bronchoscopy under intravenous anesthesia.Methods Sixty examiners were divided into three groups randomly.Every group had 20 examiners.Every group had different anesthesia approaches.The tradition anesthesia group（A） was examined by nasopharynx and trachea superficial anaesthesia.The basal anesthesia group was examined by intravenous fentanyl（1 μg/kg） infusion and midazolam（0.02 mg/kg） infusion group and was examined when OAA/S was degree 3.The venous anesthesia group was examined by intravenous fentanyl（1 μg/kg） infusion and propofol pumping（10～20 ml/h） to OAA/S degree 2.They were observed for MAP、HR、SpO2、RR、adverse reactions and the feeling of the examiner.Results The adverse reactions of the tradition anesthesia group were more than other groups.The adverse reactions of the basal anesthesia group were less and the changes of MAP、HR、SpO2、RR were not significant.The examiner of the venous anesthesia group were examined under a senseless situation without discomfort.Conclusions The basal and venous anesthsia for fiberoptic bronchoscopy are safe and feasible.The feeling of examiners is better than those of the traditional anesthesia group.The achievement ratio of fiberoptic bronchoscopy is higher than others.