脑电双频谱指数监测下镇静镇痛在支气管镜检查中的应用

Application of bispectral index monitoring in sedation and analgesia for flexible bronchoscopy

目的 探讨支气管镜检查中应用脑电双频谱指数监测下镇静镇痛的可行性.方法 纳入2016年6—12月于南京医科大学附属南京医院呼吸科行支气管镜检查的285例患者,根据患者意愿分为无痛组（局部麻醉＋清醒镇静）171例,男89例,女82例,平均年龄（59±10）岁;对照组（局部麻醉）114例,男59,女55例,平均年龄（61±12）岁.两组的年龄和性别差异无统计学意义（均P〉0.05）.比较两组检查过程中的操作时间、血压及心率等监测指标;术中不良事件的发生率;术后随访患者满意度,对操作过程的记忆率,愿意再检率;评价在非麻醉科医生、使用脑电双频指数监测下镇静镇痛在支气管镜检查中的安全性及患者的满意度.结果 无痛组操作时间和收缩压[分别为（14±5）min和（144±22）mmHg（1 mmHg=0.133 kPa）]均低于对照组[分别为（16±5）min和（153±21）mmHg],差异有统计学意义（均P〈0.01）;两组舒张压及心率[无痛组分别为（89±14）mmHg和（84±17）次/min;对照组分别为（92±12）mmHg和（87±14）次/min]差异无统计学意义（均P〉0.05）.无痛组的术中总体不良事件、呛咳及出血的发生率（分别为27%、4%和13%）均低于对照组（分别为60%、13%和35%）,差异有统计学意义（均P〈0.01）,两组一过性低氧的发生率（无痛组为12%,对照组为14%）差异无统计学意义（P=0.72）.无痛组术后随访患者满意度及愿意再检率（均为97%）明显高于对照组（均为4%）,差异有统计学意义（均P〈0.01）.结论 在支气管镜检查中应用脑电双频谱指数监测下镇静镇痛的安全性好,患者满意度高,值得临床推广使用.

Objective To investigate the feasibility of using bispectral index monitoring in sedation and analgesia for bronchoscopy . Methods Totally 285 patients admitted to the Respiratory Medicine Department of Nanjing First Hospital for bronchoscopy between June 2016 and December 2016 were assigned, according to their own wishes , into a conscious sedation group （ 171 cases receiving local anesthesia and conscious sedation , 89 males, 82 females, mean age 59 ±10 years） and a control group （114 cases undergoing local anesthesia , 59 males, 55 females, average age 61 ±12 years）.The 2 groups were compared in terms of operation time , blood pressure , heart rate and other indicators during bronchoscopy including incidence of adverse events , memory of the procedure , willingness to be re-examined, safety of sedation and analgesia for bronchoscopy under bispectral index monitoring , and patient satisfaction in the postoperative follow-up.Results The conscious sedation group and the control group had no difference in age and sex ratio （ P〉0.05 ） .Compared with the patients in the control group （ operation time 16 ±5 min and systolic blood pressure 153 ±21 mmHg,1 mmHg=0.133 kPa）, those in the conscious sedation group had a shorter operation time （ 14 ±5 min ） and a lower systolic blood pressure （ 144 ± 22 mmHg） , with statistically significant difference （ P 〈0.01 ） .There was no significant difference in diastolic blood pressure and heart rate （ 89 ±14 mmHg and 84 ±17 times/min in the conscious sedationgroup and 92 ±12 mmHg and 87 ±14 times/min in the control group, P〉0.05）.Adverse events, overall intraoperative cough and bleeding were found to be significantly reduced in the conscious sedation group （27%,4%and 13%and 60%,13%and 35%in the control group, P〈0.01）, but transient hypoxia was not （12%in the conscious sedation group ,and 14% in the control group, P=0.72）.Patient satisfaction and willingness to be re-examined were markedly higher in the conscious sedation group （97%） than in the controls （4%, P〈0.01）.Conclusions Bispectral index monitoring is safe in sedation and analgesia for bronchoscopy and has higher patient satisfaction , suggesting that it is a potential tool for use in clinical practice.