改良式胸外按压预防支气管结核患者无痛支气管镜诊疗期间低氧血症的研究

Study on the prevention of hypoxemia during painless bronchoscopy in patients with bronchial tuberculosis by modified chest compression

目的观察改良式胸外按压在预防支气管结核患者无痛支气管镜诊疗期间低氧血症的临床效果。方法选取2022年5-10月在深圳市第三人民医院行支气管镜诊疗的支气管结核患者200例,随机数表法分为对照组(C组)和试验组(T组),每组100例。麻醉方法均为静脉注射咪达唑仑+瑞芬太尼,患者意识消失后置入支气管镜,围手术期患者如发生呼吸停止达10s以上,C组予手动托下颌,T组行改良式胸外按压。如果血氧饱和度(SpO_(2))持续低于90%超过60s时,暂停支气管镜下操作,行面罩通气治疗。观察两组患者麻醉前(T0)、过声门时刻(T1)、诊疗结束时刻(T2)、离室时刻(T3)的心率(HR)、平均动脉压(MAP)、SpO_(2)变化、麻醉药用量、苏醒时间、低氧血症及诊疗中断发生情况。结果与麻醉前相比,两组术中均有MAP升高、HR增快及SpO_(2)下降,术后逐渐恢复至基础水平,但两组患者不同时点MAP、HR的比较差异无统计学意义(P>0.05)。与C组相比,T组T1、T2时点SpO_(2)维持于较高水平(P<0.05),T组低氧血症及诊疗中断的发生率明显降低(P<0.05)。两组呼吸暂停的发生率、SpO_(2)最低值和其他不良反应无明显差异(P>0.05)。T组中未出现胸痛、肋骨骨折、气胸等胸外按压相关不良反应。结论改良式胸外按压在支气管结核患者无痛支气管镜诊疗期间安全可行,可有效预防低氧血症,减少诊疗中断次数。

Objective To observe the clinical effect of modified chest compression in preventing hypoxemia in patients with bronchial tuberculosis during painless bronchoscopy.Method Select 200 patients with bronchial tuberculosis(EBTB)who underwent bronchoscopy diagnosis and treatment at Shenzhen Third People's Hospital from May to October 2022,patients were randomly assigned into two groups:control group(group C)and test group(group T),100 cases per group.The anesthesia method is intravenous injection with midazolam and remifentanil,inserting bronchoscopy after patient's consciousness disappears.During the surgery,jaw thrust(in group C)or chest compressions(in group T)was performed if apnea occurred over 10 seconds.If the state continues to deteriorate and plus oxygen saturation(SpO_(2))runs to be lower than 90%for more than 60 seconds,the staff will suspend operation and perform mask ventilation.The heart rate(HR),mean arterial pressure(MAP),SpO_(2),anesthetic dosage,recovery time,hypoxemia and times of interruption were recorded at the following time points:before anesthesia(T0),bronchoscope going through glottis(T1),end of operation(T2),leaving room(T3).Result Compared with T0,both groups had an increase in MAP,a faster increase in HR,and a decrease in SpO_(2) during surgery.After surgery,they gradually recovered to the basic level,but there was no statistically significant difference in MAP and HR between the two groups at different time points(P>0.05).Compared with group C,SpO_(2) in group T was maintained at a high level at T1 and T2(P<0.05),and the incidence of hypoxemia and interruption in group T was significantly decreased(P<0.05).There was no significant difference in the incidence of apnea,lowest value of SpO_(2),and other adverse reactions between the two groups(P>0.05).There were no chest pain,rib fracture,pneumothorax and other adverse reactions related with chest compression in group T.Conclusion Modified chest compression is a safe and feasible technique during painless bronchoscopy in patients with bronchial tuberculosis,which can effectively prevent hypoxemia and reduce the interruptions of operation.