老年患者静脉麻醉下经支气管镜针吸活检术临床应用分析

Clinical efficacy of transbronchial needle aspiration to elderly patients under the support of intravenous anesthesia

目的 探讨老年患者静脉麻醉下经支气管镜针吸活检术(transbronchial needle aspiration,TBNA)的临床应用.方法 选取2014年5月至2016年8月在我院行胸部增强CT检查提示疑似纵隔淋巴结转移,但常规气管镜检查示未见明显异常的124例老年患者,其中60例患者在静脉麻醉下行TBNA检查(静脉麻醉组),64例患者在常规局麻下行TBNA检查(局部麻醉组).两组患者均于镜检前及镜检后10、15 min检测并记录血压、血氧饱和度、呼吸频率、心率及心律等变化情况.另外,术中记录患者的症状,并于术后询问患者对检查的记忆及感受.计量资料组间比较采用t检验,计数资料组间比较采用χ2检验.结果 静脉麻醉组TBNA诊断准确率明显高于局部麻醉组(73.3%、53.1%;χ2=5.420,P<0.05).检查过程中静脉麻醉组患者收缩压/舒张压、心率、呼吸频率的波动值均显著低于局部麻醉组(t=8.422、8.767、7.445、6.423,均P<0.01);静脉麻醉组患者恶心、呛咳、窒息感、心理恐惧的发生率均显著低于局部麻醉组(t=57.197、63.147、4.774、116.234,均P<0.01).结论 老年患者在静脉麻醉下行TBNA检查操作更安全、舒适、诊断率高,值得临床推广应用.

Objective To analyze the clinical efficacy of transbronchial needle aspiration(TBNA) to elderly patients under the support of intravenous anesthesia. Methods One hundred and twenty four elderly patients suspected with mediastinal lymph node metastases through the chest enhanced CT examination were collected and received TBNA from May 2014 to August 2016 in our hospital. The patients were divided into two groups: intravenous anesthesia group(60) and general anesthesia group(64). The result of diagnostic accuracy, the change of blood pressure, SpO_2, heart rate and breathing rate, and adverse reaction were compared. Student t test was used for numeric data, and Chi-square test was used for categorical data. Results The diagnostic accuracy of TBNA were 73.3%(44/60), significantly higher than in intravenous anesthesia group 53.1%(34/64)(χ~2=5.420, P<0.05).The patients in intravenous anesthesia group had less nausea, bucking, short of breath, and fear than in control group(t=8.422, 8.767, 7.445, 6.423, and P<0.01).The turbulence of blood pressure, heart rate and breathing was less in intravenous anesthesia group than in general anesthesia group(t=57.197, 63.147, 4.774, 116.234, and P<0.01). Conclusion The TBNA operation of mediastinal lymphphadenopathy is safe, comfortable, effitive under the support of intravenous anesthesia. It is worthy of clinical application.