改良喉罩在无痛纤支镜检查中的应用

Application of improved laryngeal mask to flexible fiberoptic bronchoscopy combined with fentanyl-propofol anesthesia

目的观察改良喉罩-芬太尼复合异丙酚静脉麻醉在无痛纤支镜检查中的应用效果。方法选择ASA I～Ⅱ级拟行纤支镜检查的患者120例。随机分为喉罩组(L组,n=60)和表面麻醉组(T组,n=60)。观察两组患者检查前(T0)、插镜过声门(T1)、活检(T2)、检查毕(T3)、4个时点SPO2、MAP和HR的变化,记录L组检查后清醒时间(呼之睁眼、可回答问题),离室时间。记录纤支镜检查时间和不良反应,调查医患满意度。结果 L组SPO2、MAP、HR保持平稳,无呛咳、憋气、体动;T组检查时有呛咳、憋气、体动等,HR增快,MAP明显升高,SPO2下降。组间比较差异有统计学意义(P<0.05)。结论改良喉罩-芬太尼复合异丙酚在无痛纤支镜检查中的应用,提高了无痛纤支镜检查的舒适性、安全性,提高阳检率,获得较高医患满意度。

Objective To investigate the feasibility and safety of improved laryngeal mask to flexible fiberoptic bronchoscopy （FFB） combined with fentanyl -propofol anesthesia. Methods A total of 120 trial patients, ASA I - II grade, undergoing FFB examination were randomly assigned into LMA group （ group L, n = 60 ） and topical anesthesia group （ group T, n = 60 ）. ECG, blood pressure and oxygen saturation of patients were continuously monitored. The patients＂ Bp, HR, SpO2 at different time points were recorded during the whole process before and after the examination; the time for inserting the FFB （over the glottis） and biopsy were recorded. Besides, patients^om- plications and satisfaction were investigated. Meanwhile, the recovery .time （the duration of eye opening, directional power） and the leaving time were recorded in group L. Results In group L, Bp, HR, SpO2, mean arterial pressure （MAP） maintain stable without any move- ment, choking and suffocation. Whereas, HR, MAP were increased obviously, and Sp02 was reduced in different degrees in group T. There were significant differences in these two groups（P 〈 0.05 ）. Conclusion It is comfortable and secure of improved LMA to FFB combined with fentanyl - propofol, which also has a higher rate of positivity and patient satisfaction than topical anaesthesia.