利多卡因局部麻醉用于清醒支气管镜检查的效果和安全性研究

Study of local anesthetic effect and safety of lidocaine using in common bronchoscopy

目的 调查和评价利多卡因局部麻醉在清醒支气管镜检查的效果和安全性,为医护人员合理使用利多卡因局部麻醉提供依据.方法 选择在山东大学齐鲁医院接受首次支气管镜检查的115例清醒的住院患者为研究对象,检查前用利多卡因喉头喷雾麻醉,检查后统计患者呛咳发生率、利多卡因使用量和不良反应.气管镜检查结束5 min之内静脉采血,检测患者的血药浓度,并采用半结构式访谈法了解患者对利多卡因局部麻醉的接受程度.结果 呛咳发生率：会厌7.8％,声门17.3％,隆突上37.4％,左右主支气管39.1％,叶支气管97.4％,喉头喷雾麻醉后,会厌、声门的呛咳发生率明显低于气管及各级支气管的呛咳率（P＜0.05）;每例患者利多卡因平均使用（19.7±5.2） ml（14～25 ml）,使用10～＜15 ml占总人数的2.6％,15～＜20 ml占67.0％,20～25 ml占30.4％,使用15～＜20 ml利多卡因的患者明显多于其余2个范围的患者（P＜0.05）;利多卡因平均血药浓度（2.0±1.1） mg/L（0.5～3.6 mg/L）,均低于5 mg/L;98.3％的患者可接受利多卡因局部麻醉;主要不良反应包括血压升高30.4％,头晕、恶心6.1％,心动过缓2.6％,呼吸困难1.7％,心衰0.9％,总发生率为41.7％.结论 利多卡因局部麻醉用于清醒支气管镜检查效果可靠,认可度高且安全,适合作为支气管镜检查的麻醉方式.

Objective To investigate and estimate the local anesthetic effect and safety of lidocaine using in common bronchoscopy.Methods The incidence of cough,lidocaine volume and adverse reactions were recorded when 115 sober patients were getting bronchoscopy by lidocaine local anesthesia.Vein blood was drawed for monitoring lidocaine concentration in five minites after bronchoscopy and patients were inquired for the acceptance level of lidocaine local anesthetic by semi-structured interviews.Results The incidence of cough in epiglottis （7.8%） or glottis （17.3%） was obviously less than that in carina （37.4%）,left/right main bronchus （39.1%） and lobar bronchus （97.4%） （P 〈0.05）.The average volume of lidocaine used was （19.7±5.2） ml （14～25 ml）.The proportion of patients accepted 15～〈20 ml lidocaine （67.0%） was higher than that of patients who respectively accepted 10～ 〈15 ml lidocaine （2.6%） and 20～25 ml lidocaine （30.4%） （P 〈0.05）.The average concentration of lidocaine in blood was （2.0 ± 1.1） mg/L （0.5 ～ 3.6 mg/L）.98.3% patients could tolerate lidocaine local anesthesia.The incidence rate of adverse reactions was 41.7%,including high blood pressure （30.4%）,dizzy and nauseous （6.1%）,bradycardia （2.6%）,dyspnea （1.7%）,and heart failure （0.9%）.Conclusions Lidocaine local anesthesia using in common bronchoscopy has reliable effect,less adverse reactions,and is easily acceptable.