静脉诱导清醒镇静在支气管镜检查中的临床应用

Clinical application of conscious sedation by intravenous induction in bronchoscope examination

目的 探讨清醒镇静对患者在支气管镜检查中的耐受度、配合情况及安全性.方法 选择2012年1月至2013年6月在上海交通大学医学院附属仁济医院和复旦大学附属华东医院接受支气管镜检查的64例患者,分为,A组（清醒镇静组）和B组（安慰剂组）,所有患者均接受利多卡因局部麻醉,A组患者使用芬太尼4～5 μg/kg和咪达唑仑2 mg静脉滴注,B组患者使用0.9％生理盐水.支气管镜操作包括支气管活检,支气管刷检,支气管冲洗或支气管肺泡灌洗,观察指标分别为操作时间、操作干扰、不良事件、是否接受再次检查以及患者耐受情况.结果 操作时间B组（13.8±7.3）min,A组（14.6±5.9） min,P=0.484;活动及咳嗽干扰操作A组17例,B组21例,P=0.445;血压升高风险B组21例高于A组9例,P =0.005;氧饱和度下降风险A组14例较B组2例增高,P=0.001;术后不适情况分析,除B组有窒息感16例较A组4例明显增多外（P =0.003）,其余两组咽喉疼痛,咳嗽,恶心,头晕比较等均无统计学意义.另外确定愿意接受第二次支气管镜检查患者数A组29例较B组12例明显增多,比较具有统计学意义.耐受度方面视觉模拟评分（VAS）,A组均优于B组,P＜0.001.结论 静脉诱导清醒镇静可明显提高接受支气管镜检查及治疗患者的耐受度和减少不适感,但也存在部分风险.

Objective To explore the effect of conscious sedation on patient＇s tolerance and cooperation and safety application of in bronchoscope examination.Methods It was collected that 64 cases undergoing bronchoscope examination in Medical College of Shanghai Jiaotong University Affiliated Renji Hospital and Medical School of Fudan University Affiliated Huadong Hospital from January 2012 to June 2012.They were divided into two groups,group A （conscious sedation group） and group B （placebo）,All patients received lidocaine for upper airway preparation,patients in groups A was used alfentanil 4-5 μg/kg and 2 mg midazolam bolus,and patients in group B was used 0.9％ saline.bronchoscope operations included bronchial biopsy,bronchial brush,bronchial washing or bronchoalveolar lavage,observation index included operation time,operation interference,adverse events,whether to accept check again,and patient tolerance.Results The operation time in group B （13.8 ＋7.3）min,group A （14.6 ＋5.9）min,P =0.484; Operation interference of 17 cases in group A,21 cases in B group,P =0.445; the risk of hypertension of 21 cases in group B than 9 cases in group A,P =0.005 ; the risk of oxygen saturation decreased 14 cases in group A than 2 cases in group B,P =0.001 ; Analysis of post-procedure discomfort,except the sense of choking in group B （16 cases） more than group A（4 cases） （P =0.003）,the others （cough,nausea,dizziness,comparison and so on）were no different in two group,and more group A （29 cases） than group B （12 cases）willing to accept the re-examination.There was statistically significant.Tolerance in terms of visual analogue scale （VAS）,A group were superior to B group,P ＜ 0.001.Conclusion Conscious sedation by intravenous induction can obviously improve patients who underwent bronchoscopy tolerance and reduce discomfort,but there are some potential risks.