气管插管在无痛支气管镜介入治疗中的临床研究

Clinical Research on Endotracheal Intubation in Interventional Treatment under Painless Bronchoscope

目的探讨气管插管在无痛支气管镜介入治疗中的安全性及有效性。方法将患者分为3组:A组为常规支气管镜检查组;B组为无痛支气管镜检查组;C组为气管插管下行无痛支气管镜介入治疗组。3组均先予2%利多卡因5mL雾化吸入行表面麻醉,建立静脉通道,多参数心电监护仪监测血压、呼吸、心率及指氧饱和度。B组患者在此基础上术前静脉推注咪达唑仑0.06mg/kg和芬太尼1μg/kg。C组在B组基础上以支气管镜引导经口腔置入气管插管,然后经气管插管进行支气管镜检查和治疗。3组患者皆测定术前及术中的血压、心率,然后计算其差值。观察患者体动、短暂呼吸抑制情况及术后感受、反应。结果 B组收缩压及舒张压均有下降,C组血压波动值与A组比较差异无统计学意义(P>0.05)。3组术中心率皆有所上升,但C组与A组心率波动值要高于B组(P<0.05),C组与A组心率波动值比较差异无统计学意义(P>0.05)。C组患者体动情况及术后痛苦记忆与B组相似,要优于A组(P<0.05)。3组患者出现呼吸抑制情况比较差异无统计学意义(P>0.05)。结论经气管插管下无痛支气管镜操作安全性与常规支气管检查相似,但其术中反应及术后痛苦记忆明显优于常规支气管镜检查,值得临床推广。

Objective To investigate safety and effectiveness of endotracheal intubation in interventional therapy under painless bronchoscopy. Methods Patients were divided into three groups. Group A, the conventional bronchoscopy inspection group; Group B, the painless bronchoscope inspection group; Group C, endotracheal intubation in interventional treatment under painless bronchoscope group. Three groups were given 5 mL lidocaine （2%） aerosol inhalation. Set up the intravenous route, multi-parameter ECG for monitoring blood pressure, respiration,heart rate and oxygen saturation. Patients of Group B received intravenous midazolam injection of 0.06 mg/kg and fentanyl 1μg/kg before operation. Patients of group C were further guided by bronchoscope endotracheal intubation through oral,and then through the trachea intubation bronchoscope for examination and treatment. The blood pressure, heart rate, patients agitation, short postoperative respiratory depression and feelings were observed. Results Group B had systolic and diastolic blood pressure drop. Blood pressure changes in group C and group A did not show difference（P〉0.05）. Heart rate in three groups were all increased,but in group C and group A heart rate variations were higher than group 13 （P〈0. 05）, but no difference between group C and group A （ P〉0. 05 ）. Agitation in patients and postoperative painful memories in group C and group B were similar,and better than group A（P〈0.05）. There was no difference in respiratory depression among three groups（P〉0.05）. Conclusion The safety of endotracheal intubation in painless bronchoscopy is similar to conventional bronchoscopy. The adverse reactions and painful memories are superior to conventional bronchoscopy,and is worthy of clinical promotion.