局部麻醉伴或不伴芬太尼行支气管镜检查的对照研究

Comparative study of simple local anesthesia and local anesthesia with fentanyl for flexible bronchoscopy

目的比较局部麻醉伴或不伴芬太尼下进行常规支气管镜检查时的耐受度、满意度及安全性。方法将行常规支气管镜检查的60例患者随机分为局部麻醉不伴芬太尼镇静镇痛（A组）和局部麻醉伴芬太尼镇静镇痛（B组），每组30例。通过术中记录生命体征及不良事件观察操作的安全性，术后用视觉模拟评分（VAS）观察患者对操作的耐受度和满意度。结果两组患者术中及术后心率差异有统计学意义（P〈0．05），而两组收缩压及SaO2差异无明显统计学意义（P〉0．05）。对于操作过程中整体不适，A组患者术中比B组患者明显感觉到不适（P〈0．05），明显感觉到呼吸困难（P〈o．05），表达更多疼痛（P〈O．05），但两组患者术中咳嗽、恶心及再次检查意愿差异无统计学意义（P〉0．05）。A组l例患者和B组2例患者出现低氧血症，是短暂性的，没有生命危险。结论行常规支气管镜检查的患者采用局部麻醉联合芬太尼静脉麻醉可减少术中不适、呼吸困难及疼痛，安全性较高。

Objective To compare the tolerability, satisfaction and safety of simple local anesthesia and local anesthesia with fentanyl for conscious sedation in flexible bronchoscopy. Methods A total of 60 patients undergoing flexible bronchoscopy were randomly divided into two groups：simple local anesthesia （group A） and local anesthesia with fentanyl for conscious sedation （B group）, with 30 cases in each group. The safety of the operation was observed by the vital signs and adverse events during the operation, and the visual analogue scale （VAS） was used to observe the patient＇s tolerance and satisfaction of the operation. Results The differences of intraoperative and postoperative heart rate between two groups had statistical significance （ P〈0.05）, while the systolic blood pressure and oxygen saturation were not significantly different between the two groups （ P 〉0.05）. Compared with group B, patients in group A expressed more discomfort regarding the global tolerance of the whole procedure （ P〈0.05）. Patients in group A felt more dyspnea and pain than group B （ P 〈0.05）. However, there were no significant differences in the cough, nausea and willingness to return in two groups （P 〉 0.05）. Hypoxemia happened to one patient in group A and two patients in group B, but it was transient and no life-threatening. Conclusions Local anesthesia combined with fentanyl intravenous anesthesia can reduce discomforts, dyspnea and pain during flexible bronchoscopy, and the safety is high.