无痛技术在支气管镜检查中的应用
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摘要
目的探讨不同组别麻醉、镇静、镇痛药物下行支气管镜无痛操作技术的可行性、安全性及效费比。方法选定150例行支气管镜操作的患者,随机分配到A、B、C、D和E 5组中,每组30例,采用的给药方案分别为:A组利多卡因黏膜表面麻醉、B组利多卡因黏膜表面麻醉+右美托咪定和芬太尼静脉麻醉、C组利多卡因黏膜表面麻醉+咪达唑仑和芬太尼静脉麻醉、D组利多卡因黏膜表面麻醉+丙泊酚和芬太尼静脉麻醉、E组利多卡因黏膜表面麻醉+咪达唑仑和丙泊酚静脉麻醉,通过对支气管镜操作过程中麻醉效果、支气管镜检查反应性、操作完成情况和患者主观感受等评判,比较组别间的可行性、安全性及效费比。结果 B组和D组给药方案麻醉效果、镜下操作的反应性和患者主观感受等均优于其他组别,B组较D组更优。结论行无痛支气管镜下检查时,针对不同的患者、不同的病情给予相应的无痛给药方案更合理、安全、有效,患者更容易接受。
Objective To explore the feasibility, safety and cost-effectiveness of painless bronchoscopic technique in different groups which under different anesthesia, sedation and analgesic drugs. Methods 150 patients underwent bronchoscopy were randomly divided into the groups A, B, C, D and E. Group A: was given mucosal surface anesthesia with Lidocaine; Group B: was given mucosal surface anesthesia with Lidocaine and intravenous anesthesia with Dexmedetomidine(DEX) and Fentanyl; Group C: was given mucosal surface anesthesia with Lidocaine and intravenous anesthesia with Midazolam and Fentanyl; Group D: was given mucosal surface anesthesia with Lidocaine and intravenous anesthesia with Propofol and Fentanyl; Group E: was given mucosal surface anesthesia with Lidocaine and intravenous anesthesia with Midazolam and Propofol. During bronchoscopic operations, the feasibility, safety and cost-effectiveness of different groups were judged and compared by anesthetic effect, the reactivity of bronchoscopy, the completion of operations and the subjective feelings of patients. Results Drug regimens of Group B and D were better than other groups in the following aspects: anesthetic effects, the reactivity of bronchoscopic operations, the completion of operations and the subjective feelings of patients.Furthermore, Group B was better than Group D. Conclusions When patients who underwent painless bronchoscopy, it is more reasonable, safe and effective to provide the corresponding painless drug regimens for different patients and conditions. Which is more acceptable to patients.
Objective To explore the feasibility, safety and cost-effectiveness of painless bronchoscopic technique in different groups which under different anesthesia, sedation and analgesic drugs. Methods 150 patients underwent bronchoscopy were randomly divided into the groups A, B, C, D and E. Group A: was given mucosal surface anesthesia with Lidocaine; Group B: was given mucosal surface anesthesia with Lidocaine and intravenous anesthesia with Dexmedetomidine(DEX) and Fentanyl; Group C: was given mucosal surface anesthesia with Lidocaine and intravenous anesthesia with Midazolam and Fentanyl; Group D: was given mucosal surface anesthesia with Lidocaine and intravenous anesthesia with Propofol and Fentanyl; Group E: was given mucosal surface anesthesia with Lidocaine and intravenous anesthesia with Midazolam and Propofol. During bronchoscopic operations, the feasibility, safety and cost-effectiveness of different groups were judged and compared by anesthetic effect, the reactivity of bronchoscopy, the completion of operations and the subjective feelings of patients. Results Drug regimens of Group B and D were better than other groups in the following aspects: anesthetic effects, the reactivity of bronchoscopic operations, the completion of operations and the subjective feelings of patients.Furthermore, Group B was better than Group D. Conclusions When patients who underwent painless bronchoscopy, it is more reasonable, safe and effective to provide the corresponding painless drug regimens for different patients and conditions. Which is more acceptable to patients.
引文
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[6]贾晓琴,张健旺,牛凌慧.无痛支气管镜在呼吸疾病中的应用价值[J].西南军医,2018,20(4):456-459.[6]JIA X Q,ZHANG J W,NIU L H.Application value of painless bronchoscopy in respiratory diseases[J].Journal of Miliatary Surgeonin in Southwest China,2018,20(4):456-459.Chinese
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[8]陈伟,李卫,史忠,等.复合肌松剂下喉罩控制通气在无痛纤维支气管镜检查中的应用[J].中国内镜杂志,2016,22(1):5-9.[8]CHEN W,LI W,SHI Z,et al.Application of controlled ventilation with laryngeal mask airway combined compound muscle relaxant in fiberoptic bronchoscopy[J].China Journal of Endoscopy,2016,22(1):5-9.Chinese
[9]陈顺富,陈雷,陈栋梁,等.喉罩在无痛纤维支气管镜检查中的应用[J].中国内镜杂志,2011,17(12):1281-1283.[9]CHEN S F,CHEN L,CHEN D L,et al.Application of laryngeal mask airway the indolent fiberoptic bronchoscopy[J].China Journal of Endoscopy,2011,17(12):1281-1283.Chinese
[10]李新科,汪金锋.改良无痛纤维支气管镜技术的临床应用探讨[J].中国内镜杂志,2010,16(4):367-369.[10]LI X K,WANG J F.Investigation on the painless fibrobronchoscopy for clinical practice[J].China Journal of Endoscopy,2010,16(4):367-369.Chinese
[2]SILVESTRI G A,VINCENT B D,WAHIDI M M,et al.A phase 3,randomized,double-blind study to access the efficacy and safety of fospropofol disodium injection for moderate sedation in patients undergoing flexible bronchoscopy[J].Chest,2009,135(1):41-47.
[3]STOLZ D,CHHAJED PN,LEUPPI J,et al.Nebulized lidocaine for flexible bronchoscopy:a randomized,double-blind,placebocontrolled trial[J].Chest,2005,128(3):1756-1760.
[4]张宁,孙宝民,程燕,等.地塞米松复合右美托咪定对臂丛神经阻滞效果的影响[J].河北医科大学学报,2016,37(8):935-939.[4]ZHANG N,SUN B M,CHENG Y,et al.Influence of dexamethasone combined with dexmedetomidine on interscalene brachial plexus block[J].Journal of Hebei Medical University,2016,37(8):935-939.Chinese
[5]陈剑,刘才堂,刘培斌,等.丙泊酚和芬太尼应用于无痛纤维支气管镜检查的效果分析[J].宁夏医学杂志,2006,28(5):386-387.[5]CHEN J,LIU C T,LIU P B,et al.Effect analysis of propofol and Fentanyl on painless fiberoptic bronchoscopy[J].Ningxia Medical Journal,2006,28(5):386-387.Chinese
[6]贾晓琴,张健旺,牛凌慧.无痛支气管镜在呼吸疾病中的应用价值[J].西南军医,2018,20(4):456-459.[6]JIA X Q,ZHANG J W,NIU L H.Application value of painless bronchoscopy in respiratory diseases[J].Journal of Miliatary Surgeonin in Southwest China,2018,20(4):456-459.Chinese
[7]李亚平,陈翠萍,陶慧玲.无痛性纤维支气管镜的临床应用[J].山西医药杂志,2008,37(2):176-178.[7]LI Y P,CHEN C P,TAO H L.Clinical application of painless fiberoptic bronchoscopy[J].Shanxi Medical Journal,2008,37(2):176-178.Chinese
[8]陈伟,李卫,史忠,等.复合肌松剂下喉罩控制通气在无痛纤维支气管镜检查中的应用[J].中国内镜杂志,2016,22(1):5-9.[8]CHEN W,LI W,SHI Z,et al.Application of controlled ventilation with laryngeal mask airway combined compound muscle relaxant in fiberoptic bronchoscopy[J].China Journal of Endoscopy,2016,22(1):5-9.Chinese
[9]陈顺富,陈雷,陈栋梁,等.喉罩在无痛纤维支气管镜检查中的应用[J].中国内镜杂志,2011,17(12):1281-1283.[9]CHEN S F,CHEN L,CHEN D L,et al.Application of laryngeal mask airway the indolent fiberoptic bronchoscopy[J].China Journal of Endoscopy,2011,17(12):1281-1283.Chinese
[10]李新科,汪金锋.改良无痛纤维支气管镜技术的临床应用探讨[J].中国内镜杂志,2010,16(4):367-369.[10]LI X K,WANG J F.Investigation on the painless fibrobronchoscopy for clinical practice[J].China Journal of Endoscopy,2010,16(4):367-369.Chinese