气管内表面麻醉在无痛纤维支气管镜检查与治疗中的应用

Endotracheal Surface Anesthesia Compared to Compound Intravenous General Anesthesia in Painless Fiber Bronchoscope Examination and Treatment

【目的】观察气管内表面麻醉在喉罩通气无痛纤维支气管镜检查与治疗中的应用效果。【方法】选择拟行纤维支气管镜检查与治疗的成人患者90例，ASA分级Ⅰ～Ⅱ级，随机分成三组，每组30例。三组患者均以异丙酚2mg／kg加瑞芬太尼2μg／kg，诱导后插入喉罩，接麻醉机。Ⅰ组（气管内表面麻醉组）应用纤维支气管镜经喉罩过声门给予2％利多卡因5～10mL行气管内表面麻醉。Ⅱ组（小剂量肌松组）经静脉给予小剂量维库溴铵0．02～0．04mg／kg，Ⅲ组（单纯静脉麻醉组）经静脉泵入丙泊酚4～6mg／（kg·h）维持麻醉。其中Ⅰ、Ⅱ组视患者体动与咳嗽反射情况间断追加丙泊酚0．5～1mg／kg，Ⅲ组间断追加瑞芬太尼0．5～1μg／kg，分别记录诱导前（T1），插入喉罩时（T2）、检查开始后5min（T3）、10rain（T4）、麻醉苏醒时（T5）患者的收缩压、心率；同时记录患者检查中咳嗽、体动反应情况及麻醉苏醒时间及丙泊酚和瑞芬太尼的用量。【结果】三组患者收缩压和心率在T1，T2，T5时间点相比较差异无显著性（P〉0．05），T1和T2时间点Ⅲ组患者明显低于Ⅰ和Ⅱ组（P〈0．05）；咳嗽、体动反应次数，Ⅲ组多于Ⅰ和Ⅱ组（P〈0．05）；Ⅱ组苏醒时间明显长与Ⅰ和Ⅲ组（P〈0．05）；丙泊酚和瑞芬太尼的用量，Ⅲ组明显多于Ⅰ和Ⅱ组（P〈0．05）。【结论】在喉罩通气无痛纤维支气管镜检查与治疗中，应用2％利多卡因气管内表面麻醉能减低患者检查中的血压和心率波动，减少患者的咳嗽和体动反应，缩短麻醉苏醒时间和减少静脉麻醉药物的用量。

[Objective]To observe the clinical application effect of endotracheal surface anesthesia in painless fiber bronchoscope examination and treatment with laryngeal mask airway. [Methods]90 cases of adult patients with fiber bronchoscope were chosen. According to ASA Ⅰ～Ⅱ , the patients were randomly divided into three groups, 30 cases in each group. All three groups of patients used propofol 2 mg/kg and fentanyl 2 ug/kg, inserted with a laryngeal mask after induction, then connected to the anesthesia machine. In Group Ⅰ （endotracheal surface anesthesia group）, applied fiber bronchoscope through laryngeal mask via the glottis gave 20% lidoeaine 5-10 mL executing endotracheal surface anesthesia. In Group Ⅱ （small dose of muscle relaxant）, intravenously given small dose of vecuronium bromide 0.02-0.04 mg/kg. In Group Ill （simple intravenous anesthesia group）, propofol 4-6 mg/kg.h, was used to maintain anesthesia with an intravenous pump. According to the condition of patients＇ body movements and cough reflexes, superadditon propofol 0.5-1mg/kg in group Ⅰ and Ⅱ, added fentanyl 0.5- 1 μg/ kg in group Ⅲ. Respectively recorded the patients systolic blood pressure （SBP） and heart rate （HR） at the induction time （T1）, before inserting laryngeal mask （T2）, after beginning examination 5 minutes （T3）, 10 minutes （T4）, and time awoken from anesthesia （T5）. Results were recorded to the degree of patients with cough or body movement response and anesthetic awake time paired with the corresponding dosages of propofol and fentanyl. [ResultslIn the three groups, SBP and HR had no statistical significance at T1 , T2 , and T3 （ P 〈0.05）. The SB- PP and HR in group Ⅲ were obviously lower than than in Group Ⅰ and Ⅱ at Ts and T4 （ P 〈0.05）. The length of coughs and body movements in Group Ⅲ was much higher than that in Group Ⅰ and Ⅲ （ P 〈0.05）. The awake time in Group Ⅱ was significantly longer than that in Group and Ⅰ and Ⅲ （ P 〈0.05）. The dosage of propofol and fentanil in Group Ⅲ was significantly more than than in Group Ⅰ and Ⅱ （ P 〈0.05）. [Conelusion]ln painless fiber bronchoscope treatment, the application of 2% lidocaine endotracheal surface anesthesia can reduce the patients MAP and HR fluctuations, reduce the patient＇s cough and body movement response, shorten the anesthesia awake time, and reduce the dosage of intravenous anesthesia drugs. [Key words] Anesthesia, Intratracheal; Bronchoscopy; Laryngeal Masks; Anesthesia, Intravenous