3种麻醉方法应用于经气管超声内镜引导针吸活检术的探讨  

The efficiency of different anesthesia methods in endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA)

作　　者：王昕[1] 徐铮[1] 尹华[1] 谭志明[1] 

机构地区：[1]复旦大学附属肿瘤医院麻醉科,复旦大学上海医学院肿瘤学系,上海200032

出　　处：《中国癌症杂志》2010年第8期630-633,共4页China Oncology

摘　　要：背景与目的:经气管超声内镜引导针吸活检术(endobronchial ultrasound-guided transbronchial needle aspiration,EBUS-TBNA)在纵隔淋巴结诊断中的运用日趋广泛,但涉及麻醉方法的文献报道甚少。本研究探讨3种不同麻醉方法在EBUS-TBNA的应用比较。方法:从2009年1～11月,60例美国麻醉医师协会(ASA)Ⅰ或Ⅱ级,年龄35～65岁,因纵隔淋巴结肿大需行EBUS-TBNA患者,按手术顺序分为:气管及声门表面麻醉复合静脉镇静(T组)、静脉麻醉(R组)和全身麻醉(G组),每组20例。T组使用2%利多卡因5mL经环甲膜注入行气管表面麻醉后TCI丙泊酚3μg/(kg·min);R组TCI丙泊酚4μg/(kg·min)及瑞芬太尼5ng/mL;G组TCI丙泊酚4μg/(kg·min)和瑞芬太尼5ng/mL,顺式阿曲库铵0.25mg/kg为诱导剂量,按需间断静注顺式阿曲库铵0.1mg/kg。3组患者均在入睡后置入喉罩,T组保留自主呼吸;R组和G组潮气量设置为8mL/kg行容量控制机械通气。观察记录患者入室、诱导后即刻、喉罩置入时、超声探头置入时、术毕、术后30min时患者桡动脉血压、心率、脉搏氧饱和度、动脉血氧分压、二氧化碳分压、BIS值,以及患者呛咳和呼吸抑制次数、术中并发症、手术时间,术者暂停手术操作次数、术后24h恶心呕吐次数、术后卧床时间等指标。结果:T组患者在置入喉罩和内镜进入声门时血压、心率与基础值相比变化不明显。部分患者镇静后有一过性呼吸抑制。R组诱导后血压低于基础值(P<0.05),内镜进入声门时部分患者发生呛咳及术后有恶心呕吐发生。G组诱导后至术毕平均血压低于基础值(P<0.05),患者发生恶心呕吐及苏醒时间、术后卧床时间明显高于T组和R组(P<0.05),无呛咳反应发生。结论:气管及声门表面麻醉复合镇静和静脉麻醉,与全身麻醉相比,能够更安全地应用于EBUS-TBNA。Background and purpose：Endobronchial ultrasound-guided transbronchial needle aspiration （EBUS-TBNA） has been increasingly used for the diagnosis of mediastinal lymph nodes biopsy, but the involved anesthesia method has rarely been reported when EBUS-TBNA is adopted. This article discussed the 3 different anesthetic techniques applied to the EBUS-TBNA in order to compare its efficiency and safety. Methods：From January to November in 2009, 60 patients with ASA Ⅰ or Ⅱ grade and ages 35-65 who underwent EBUS-TBNA due to enlargement of mediastinal lymph nodes, were divided into 3 groups （20 patients each）： T group for the topical anesthesia of trachea combined with intravenous sedation, R group for intravenous anesthesia, and G group as the general anesthesia group. In T group 2% lidocaine, 5 mL was injected into the trachea and TCI propofol 3 μg/（kg·min） through the cricothyroid membrane. For the R group, the TCI propofol was injected with 4 μg/（kg·min） and remifentanil of 5 ng/mL. G group’s TCI was injected with 4 μg/（kg·min） propofol and remifentanil 5 ng/mL, cis-atracurium 0.25 mg/kg for the induction dose, and intermittent intravenous cis-atracurium 0.1 mg/kg was on demand. After induction, all patients were inserted with LMA. In response, T group remained spontaneously breathing whereas R group and G group set a tidal volume of 8 mL/kg with the help of mechanical ventilation. The patients were observed and recorded as following： radial artery blood pressure, heart rate, pulse oxygen saturation, arterial partial pressure of oxygen, carbon dioxide partial pressure of , BIS values at a few crucial points （basic vital signs immediately after induction, LMA insertion point, the ultrasound probe insertion point, examination was completed 30 minutes after examination）, frequency of cough and respiratory depression,nausea and vomiting within a 24 hour period, surgery suspended and intraoperative complications, operation time and time of bed rest. Results：The blood pressure a

关 键 词：经气管镜超声引导针吸活检术 麻醉 局部 麻醉 静脉 麻醉 全身麻醉 

分 类 号：R614[医药卫生—麻醉学]