改良无痛气管镜检查的临床研究  

Clinical study of improved painless management with fiberoptic bronchoscopy

作　　者：徐锋 梁希军 马红梅 朱劲松 

机构地区：[1]沧州市人民医院呼吸内科,061000

出　　处：《国际呼吸杂志》2011年第14期1071-1073,共3页International Journal of Respiration

基　　金：沧州市科学技术研究与发展指导计划项目（10ZD59）

摘　　要：目的研究无痛支气管镜诊疗时利多卡因表面麻醉联合曲马多、地西泮静脉注射的麻醉效果与安全性。方法200例患者随机分为治疗组（利多卡因表面麻醉联合静脉注射地西泮和曲马多）和对照组（单纯利多卡因表面麻醉），每组100例。表面麻醉方法为利多卡因氧气加压口鼻面罩雾化，鼻腔、气管内滴药，连续观察患者在支气管镜诊疗前、过程中血压、心率、呼吸频率、血氧饱和度变化。询问咽部不适、咳嗽、喉痉挛、疼痛、乏力、头晕、憋气、遗忘程度及对下次操作能否接受。结果治疗组患者支气管镜操作前、中的平均心率、血压无明显改变（P〉0．05），而对照组患者操作前、中平均心率明显升高（P〈0．001），组间差异存在显著性（P〈0．001）。对照组患者操作中的平均血氧饱和度下降，治疗组氧饱和度无明显变化，其变化两组间差异存在显著性（P〈0．001）。治疗组患者术后对操作的遗忘率高，90％表示能接受下次操作，而对照组患者对操作的不良记忆多，仅51．7％表示愿意接受下次操作，两组比较差异有显著性（P〈0．001）。结论利多卡因表面麻醉加用曲马多、地西泮静脉注射用于无痛支气管镜诊疗时可以获得满意的麻醉效果，安全有效，优于常规局麻法。Objective To explore the effect and safety of diazepam plus tramadol intravenous combined lidocaine surface anesthesia in patients under going painless fiberoptic bronchoscopy. Methods 200 patients were separated randomly into two groups：lidocaine surface anaesthesia group （group A）and lidocaine surface anaesthesia combined diazepam plus tramadol intravenous group （group B）. Patients＇ heart rate （HR）,breathe rate, blood pressure （BP） and oxygen saturation （SpO2） before and during the operation were observed. Their cough, pain, feeble, dizziness, suffoduring the operation were counted. Then all patients were asked about the operation experience. Results Compared to the data, the mean HR and BP before and during the operation be showed significant increased in group A （ P 〈0. 001） and not in group B （ P 〉0.05）. Mean SpO2 during the operation decreased significantly in group A,only 51.7% of the patients agreed to accept the next one,and no significant difference showed in group B. There were more bad memory after the operation in group A. Nevertheless, 90% of the patients in group B were willing to accept another operation （ P 〈 0. 001 ）. Conclusions Lidocaine surface anaesthesia plus tramadol and diazepam in painless fiberoptic bronchoscopy is safe and effective.

关 键 词：支气管镜 无痛 利多卡因 曲马多和地西泮 

分 类 号：R614[医药卫生—麻醉学]