无创通气联合镇静下纤维支气管镜检查在呼吸衰竭患者中的应用

Application of fiberoptic bronchoscopy assisted by noninvasive ventilation and sedation in patients with respiratory failure

目的探讨呼吸衰竭患者在无创通气联合镇静下行纤维支气管镜检查的可行性及安全性。方法将2018年1月至2019年1月北京大学首钢医院呼吸监护室收住的100 mmHg<氧合指数<200 mmHg(1 mmHg=0.133 kPa)、具有气管镜检查适应证的患者32例,根据病情需要进行支气管肺泡灌洗、保护性毛刷刷检、活检等操作。16例患者随机分入无创通气联合镇静组(丙泊酚镇静),16例随机分入无创通气非镇静组。主要观察终点是气管镜检查过程中患者氧合指数、生命体征的变化,患者的感受度及检查完成后1 h及24 h内气管插管率的比较。结果在气管镜检查过程中,镇静组患者的氧合指数增加了18%,非镇静组氧合指数增加了6%。镇静组患者心率、血压及呼吸频率下降,非镇静组患者心率、血压增高。镇静组气管镜检查所需时间更短。镇静组大部分患者操作过程中无明显不适,并同意必要时再次气管镜检查;非镇静组大部分患者有明显不适,包括呼吸困难、咳嗽、疼痛等,仅有少数患者同意再次气管镜检查。2组大部分患者得到了确诊。结论对于严重呼吸衰竭患者,无创通气联合镇静下气管镜检查是安全可行的。

Objective To discuss the feasibility and safety of fiberoptic bronchoscopy assisted by noninvasive positive pressure ventilation(NPPV)and sedation in patients with respiratory failure.Methods Thirty-two patients with 100 mmHg<oxygen index<200 mmHg(1 mmHg=0.133 kPa)who required bronchoscopy in Peking University Shougang Hospital from January 2018 to January 2019 were entered into the study.Procedures included bronchoalveolar lavage,protective cell brushing,endobronchial biopsy and others were performed if needed.Sixteen patients were randomized to receive NPPV and sedation by propofol during bronchoscopy,and 16 patients were put to receive NPPV without sedation.The primary end points were changes in oxygen index,vital signs during bronchoscopy,patients perception and intubation rate within one hour and 24 hours of terminating the procedure.Results During bronchoscopy,the oxygen index increased by 18% in sedation group and 6% in non-sedation group.Heart rate,blood pressure and respiratory rate decreased in sedation group,while heart rate and blood pressure increased in non-sedation group.The time required for bronchoscopy was shorter in sedation group.Most patients in sedation group had no obvious discomfort during operation,and agreed to accept another bronchoscopy when necessary.Most patients in non-sedation group had obvious discomfort,including dyspnea,cough,pain,only a few patients agreed to accept bronchoscopy again.Most of the patients in both groups were diagnosed.Conclusions In patients with severe respiratory failure,fiberoptic bronchoscopy assisted by non-invasive ventilation and sedation is feasible and safe.