经鼻咽喷射局麻药表麻联合深度镇静在气管镜检查中的应用

Transnasopharyngeal spray topical anesthesia with sedation for tracheobronchoscopy

目的探讨经鼻咽通气道气管内表麻联合深度镇静麻醉方法在气管镜检查中的效果、安全性和可行性。方法选择需行支气管镜检查的患者60例。采用随机数字表法将患者分为2组(n=30):环甲膜局部麻醉组(C组)和鼻咽通气道局部麻醉组(E组)。C组患者在患者入室后经环甲膜穿刺气管内表麻,并常规鼻吸氧疗;E组患者在入室后吸气期经鼻咽通气道喷射诱导咳嗽气管内表麻,并经鼻咽通气道吸氧疗。2组均静脉注射丙泊酚和瑞芬太尼,达到镇静深度(Ramsay>4分)时手术医师置入纤支镜。观察的主要结局是2组患者术中低氧血症发生率;次要结局为入室(T0)、环甲膜穿刺后及鼻咽通气道置入后(T1)、至声门(T2)、至隆突(T3)、清醒时(T4)等时间点的平均动脉压、心率、托下颌、退镜、术中利多卡因总量、手术时间、恢复时间、医生和患者满意度、丙泊酚、瑞芬太尼的用量、咳嗽评分以及其他术中并发症包括术后咽痛、恶心、呕吐和鼻出血的发生率。结果主要结局:与C组比较,E组术中发生低氧血症发生率明显降低(P<0.05)。次要结局:2组利多卡因总量无统计学差异(P>0.05);与C组比较,E组托下颌例数、退镜例数明显减少(P<0.05);与C组比较,E组手术时间明显缩短、医患满意度明显增高、瑞芬太尼用量明显减少(P<0.05);两组恢复时间、丙泊酚用量、咳嗽评分及术后并发症差异均无统计学意义(P>0.05)。结论经鼻咽通气道通气联合喷射局麻药诱导咳嗽的局部麻醉方式,可以防止术中发生低氧血症发生率,缩短手术时间,提高手术医师和患者的满意度。

Objective To test the effect,safety and feasibility of transnasopharyngeal spray topical anesthesia with deep sedation for tracheobronchoscopy.Method 60 patients undergoing tracheobronchoscopy were included and assigned equally into two groups by random number table:the thyrocricocentesis topical anesthesia group(Group C)and the nasopharyngeal spay topical anesthesia group(Group E)Patients in Group C were anesthetized by puncturing the trachea through the cricothyroid membrane after entering the room,and received nasal oxygen;Group E patients obtained tracheal surface anesthesia by induced cough through nasopharyngeal airway spraying,and oxygen was supported through nasopharyngeal airway.Both groups were sedated by intravenous propofol and remifentanil.When Ramsay scale is more than 4,fiberoptic bronchoscope was allowed to insert.The main outcome variable was the incidence of intraoperative hypoxemia in both groups;The secondary outcomes included mean arterial pressure and heart rate at time points such as preoperative(T0),puncture of the cricothyroid membrane or placement of the nasopharyngeal airway(T1),tracheobronchoscope reach the glottis(T2),reach the carina(T3),and the time awake(T4);supporting the lower jaw;tracheobronchoscope retraction;Total amount of lidocaine during surgery;surgery time;recover time;doctor convenience and patient satisfaction;dosage of propofol and remifentanil;incidence of cough score and other intraoperative complications including postoperative sore throat,nausea,vomiting,and nosebleed.Results Primary outcome:Compared with group C,the incidence of intraoperative hypoxemia was significantly reduced in Group E(P<0.05).Secondary outcome:there was no statistical difference in the total amount of lidocaine in the two groups(P>0.05);compared with group C,the number of jaw support and withdrawal decreased significantly(P<0.05);compared with group C,operation time was significantly shorter,doctor-patient satisfaction increased,and remifentanil was significantly decreased(P<0.05);the difference in recovery time,propofol dosage,cough score and postoperative complications were not statistically significant(P>0.05).Conclusion Transnasopharyngeal spray induced cough can achieve satisfactory topical anesthetic effects for tracheobron-choscopy.This technique can reduce the incidence of intraoperative hypoxemia,shorten the operation time,and improve the satisfac-tion of surgeons and patients。