两种局麻联合小剂量静脉麻醉在支气管镜的应用

Evaluation of Two Local Anaesthesias Combinated With Low Dose Intravenous Anaesthesia in Bronchoscopy

目的探讨在可弯曲支气管镜检查中,采用两种局麻联合小剂量静脉麻醉的可行性及安全性分析。方法将90例适合做支气管镜检查的患者随机分为观察组和对照组。观察组采用2%利多卡因雾化吸入及环甲膜穿刺法局部麻醉,并在此基础上加用小剂量咪达唑仑+舒芬太尼静脉麻醉。对照组在局部麻醉基础上静脉注射0.9%氯化钠作对照。记录两组术前、支气管镜过声门进入主气道时、活检、肺泡灌洗时心率(heart rate,HR)、收缩压(systolic blood pressure,SBP)、呼吸(respiration,RR)变化的最高值及脉搏氧饱和度(pulse oxygen saturation,SPO2)的最低值;术中配合度;利多卡因耗药量;术后患者主观不适感和满意度。结果两组患者在支气管镜过声门时SBP及HR均升高,RR加快,对照组升高更显著;活检及肺泡灌洗时观察组SBP、HR及RR回到术前水平,对照组仍高于术前水平;两组过声门SPO2均下降,观察组下降更明显。术中配合度观察组优于对照组,利多卡因耗药量少于对照组,主观不适感少于对照组,满意度高于对照组。结论支气管镜检查采用2%利多卡因雾化吸入及环甲膜穿刺局麻基础上,联合小剂量静脉麻醉使患者在清醒状态下配合检查,生命体征较平稳,安全性好,提高了患者的耐受性和满意度,但需注意把握好适应症。

Objective To evaluate the feasibility and safety of combination of two local anaesthesias and low dose intravenous anaesthesia in flexible bronchoscopy.Methods 90 bronchoscopy candidates were divided randomly into observation group and control group.Patients in observation group accepted inhalation of 2%lidocaine,injection of local anesthesia by cricothyroid puncture,and intravenous anesthesia of low dose midazolam and sufentanil.In the control group,0.9%sodium chloride was injected intravenously on the basis of local anesthesia.We collected the heart rate,the systolic blood pressure(SBP),respiratory rate(RR)and the lowest pulse oxygen saturation(SPO2)of patients before surgery,or during bronchoscopy entered through glottis,or biopsy or during alveolar lavage.We also collected the intraoperative cooperation degree,lidocaine consumption,and postoperative questionnaire survey of patients’subjective discomfort and satisfaction.Results The heart rate,the systolic,and respiratory rate increased in both groups during bronchoscopy entered through glottis,with more increase in observation group.In observation group,the systolic blood pressure,heart rate and respiratory rate during biopsy and alveolar lavage returned to the preoperative level.While those in control group were still higher than those before bronchoscopy.The pulse oxygen saturation in both groups decreased during bronchoscopy entered through glottis,with more decrease in observation group.The intraoperative cooperation degree in observation group was better than that in control group.Patients in observation group had more lidocaine consumption than that in control group.Patients in observation group had more discomfort and better satisfaction than that in observation group.Conclusion Inhalation 2%lidocaine and injection of local anesthesia by cricothyroid puncture,combinating with intravenous anesthesia can make patients corporate well,quietly and soberly.And it can also make patients keep stable vital sign and is more safe with participation and administration from anesthesiologist.Meanwhile it can improve tolerance and satisfaction,but the indications should be emphasized.