【摘要】 目的观察复合静脉麻醉用于诊断性可弯曲支气管镜检查的临床效果和安全性。方法30例常规组仅用表面麻醉,37例静脉麻醉组除表面麻醉外还静脉给予咪唑安定、芬太尼和异丙酚。观察两组的术前紧张度;检查前和检查中血压、心率、血氧饱和度变化;内镜医师的满意度、受检者的接受度和满意度;不良事件发生情况。结果两组患者在纤维支气管镜入声门时均出现血压增高和心率加快(与基础值比较,P<0.000 1),常规组的血压上升和心率加快比静脉麻醉组显著(P<0.001)。在两侧支气管检查过程中静脉麻醉组的血压基本回到基础值,而常规组仍显著高于基础值(P<0.000 1);两组在入声门及检查中均有氧饱和度下降(与基础值比较,差异有显著性),但静脉麻醉组的下降较常规组严重(P<0.05);静脉麻醉组在镜检中出现PaCO2的上升,与术前基础值相比差异有显著性(P<0.000 1);常规组术前紧张度高于静脉麻醉组,但无统计学意义;内镜医师对纤维支气管镜操作的总体满意度两组无显著性差异,而患者的总体满意度静脉麻醉组显著高于常规组(P<0.000 01);静脉麻醉组78.4%愿意再次接受检查,常规组仅为16.7%;静脉麻醉组不良事件发生情况多于常规组。结论可弯曲支气管镜检查使用复合静脉麻醉减轻了病人的痛苦,大大提高了受检者的满意度和接受度。但在一定程度上降低了安全性,需把握好适应证并加强监护。更多还原

【Abstract】 Objective To evaluate the efficacy and safety of diagnostic flexible bronchoscopy with combined intravenous anesthesia.Methods 37 subjects who prepared to take bronchoscopy examination were administered intravenously with midazolam,fentanyl and propofol combined with topical anesthesia meanwhile 30 subjects with topical anesthesia only were selected as controls.Blood pressure(BP),heart rate(HR)and oxygen saturation by pulse oximetry were monitored continuously before and during bronchoscopy.The degrees of stress and satisfaction of patients and physicians were measured by Visual Analog Scale(VAS)as well as adverse events were recorded.Results BP and HR increased when the bronchoscope went through glottis both in intravenous and in topical anesthesia groups compared with baseline(P<0.000 1)although the increment was more significant in topical group.Then patient’s BP gradually dropped to baseline in intravenous group but stayed at a higher level in topical group.Oxygen desaturation and carbon dioxide retention were observed in both groups but were more severe in intravenous group.The physician’s satisfaction about the bronchoscopic procedure was similar in topical group and intravenous group,however,patient’s satisfaction was much better in intravenous group.The acceptance to bronchoscope procedure in intravenous group was 78.4%,much better than that of 16.7% in topical group.A tendency of more adverse events was observed in intravenous group.Conclusions Diagnostic flexible bronchoscopy with combined intravenous anesthesia alleviated the patient’s distress and greatly improved the patient’s compliance and acceptance.Special consideration on adverse effects and cautious surveillance must be made.更多还原