改良麻醉在呼吸衰竭患者支气管镜检查的应用

Application of improved anesthesia in patients with respiratory failure received bronchoscopy

目的探讨咪达唑仑联合曲马多静脉推注加2%利多卡因局部麻醉在呼吸衰竭患者纤维支气管镜检查的安全性及可行性。方法将符合支气管镜检查适应症的患者并血气分析提示呼吸衰竭者为观察组,共64人,无合并呼吸衰竭组为对照组,共76人。两组均采用气管镜检查前15min雾化吸入2%利多卡因,术前静脉推注咪达唑仑+曲马多,术中分别于腔内喷洒2%利多卡因局部麻醉。比较两组患者术前、术中、术后心率(HR)、指脉氧饱和度(SPO_2)、呼吸频率(RR)、术中不良反应、术中知晓情况。结果术前观察组HR、RR高于对照组,SPO2低于对照组,(P<0.05)。术中两组患者HR、RR、SPO_2变化差异无统计学意义(P>0.05)。术后两组RR、SPO_2变化差异无统计学意义(P>0.05),HR变化差异有统计学意义,观察组较对照组快(P<0.05)。两组患者术中不良反应发生率差异无统计学意义(P>0.05),均无严重不良反应。两组患者术中知晓率差异无统计学意义(P>0.05)。结论咪达唑仑联合曲马多静脉推注加2%利多卡因局部麻醉在合并呼吸衰竭患者支气管镜检查应用中安全可行,未见明显不良反应,术中知晓率低。

Objective To investigate the safety and feasibility of intravenous injection of midazolam combined with tramadol and local anesthesia with 2% lidocaine for bronchofiberscopy in patients with respiratory fail- ure. Methods Patients met with indications of bronchoscopy were enrolled, including patients with respiratory fail- ure indicated by blood gas analysis as the observation group （ n = 64） and patients without respiratory failure as the control group （n = 76 ）. All the patients received atomizing inhalation of 2% lidocaine 15 minutes before bronchosco- py, and intravenous injection of midazolam and tramadol before operation, and local anesthesia with intracavity spra- ying of 2% lidocaine during operation. The heart rate （HR）, SpO2 by finger, respiratory rate （RR） before, after and during operation, and adverse reactions and consciousness during operation were compared between the two groups. Results HR and RR were higher, and SpO2 was lower in the observation group than in the control group （P 〈 0.05 ）. The differences suggested no statistical significance in HR, RR, or SpO2 during operation （P 〉 0. 05 ）. There was no significant differences in RR and SpO2 after operation （ P 〉 0. 05 ）. HR in the observation group was higher than that in the control group （ P 〈 0. 05 ）. No statistical significance was noticed in the incidence of adverse reactions between the two groups during operation （ P 〉 0.05 ）, no serious adverse reactions being noted. There was no statistical significance in consciousness rate during operation （ P 〉 0. 05 ）. Conclusion Intravenous injection of midazolam combined with tramadol and local anesthesia with 2% lidocaine is safety, feasibility and has no obvious adverse reactions in the application of bronchoscopy for respiratory failure patients, with low consciousness rate during operation.