【摘要】 目的:探讨无痛苦纤支镜诊疗技术中三种通气方法的效果及安全性。方法:78例患者在咽喉部表面麻醉后,复合小剂量芬太尼及异丙酚静脉麻醉下行纤支镜检查或治疗。根据通气方法不同随机分为3组:I组采用鼻导管给氧,氧流量4L/min;II组行气管插管;III组置入喉罩通气。监测麻醉前、麻醉后(术中5min、15min)及完全清醒时的ECG、BP、RR、HR、SpO2,记录术中术后不良反应,术后调查受检者对检查过程的感受。结果:3组受检者麻醉诱导平稳,I组受检者检查中(5min、15min)SpO2明显低于II、III组,部分患者需暂停检查;II、III组受检者各时间点生命体征平稳,SpO2无明显下降,II组受检后出现咽痛不适等并发症较III组多。结论:I组通气法操作简便,但不能保证术中供氧,适用于肺功能较好、操作时间较短的气道检查;II、III组通气法安全性高,适用于较长时间的气道操作以及肺功能不全患者的检查,III组具有II组控制气道优点,纤支镜操作更方便,术后咽痛并发症少,是理想的通气方式。更多还原

【Abstract】 Objective:To evaluate the efficacy and safety of three ventilation methods in fibrobronchoscopy examination and therapy. Methods:Seventy-eight subjects undergoing bronchoscopy examination were administered intravenously with fentanyl and propofol combined with topical anesthesia.The patients were divided into three groups:the patients in group I received oxygen by nasal tubes,the flow rate of 4L/min.The patients in group II received oxygen with tracheal intubation (TI).The patients in group III were ventilated with laryngeal mask airway (LMA). Examination time, propofol dose, blood pressure (BP), heart rate (HR) and oxygen saturation by pulse oximetry (SpO2) were monitored continuously before and during bronchoscopy. The degrees of stress and satisfaction of patients were measured as well as adverse events were recorded.Results:All the three groups were fluent in anesthesia induction and experienced drop of BP. Oxygen desaturation (P<0.05) were observed in group I (5,15 min) and 15 patients had to pause the examination.The patients with pharyngalgia were significantly more (P<0.05) in group II than in other groups.Conclusion:Oxygen supply by nasal tubes was easy to execute, but it could not guarantee the oxygen saturation.So it is more fit for those patients with good lung functions and short time procedure. Methods of oxygen supply with TI and LMA are both safer and fit for the patients with poor lung functions or long time procedure.Because LMA could control the air way to ease the examination and has less complications,it is an ideal method of ventilation for fibroscopy.更多还原