气道内喷洒利多卡因联合含服达克罗宁胶浆在支气管镜诊疗中的应用  

Efficacy and Safety of Intratracheal Spraying of Lidocaine Combined with Oral Intake of Dyclonine Mucilage in Flexible Bronchoscopy

作　　者：郑冠英[1] 林桂阳[1] 陈文树 林昌健 庄顺云 Zheng Guanying;Lin Guiyang;Chen Wenshu(Department of Pulmonary and Critical Care Medicine,Shengli Clinical Medical College of Fujian Medical University,Fujian Provincial Hospital,Fuzhou 350001,China;Department of Thoracic Surgery,Shengli Clinical Medical College of Fujian Medical University,Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学省立临床医学院,福建省立医院呼吸与危重症医学科,福州350001 [2]福建医科大学省立临床医学院,福建省立医院胸外科,福州350001

出　　处：《华中科技大学学报（医学版）》2020年第4期491-494,499,共5页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：福建医科大学启航基金项目(No.2016QH114)。

摘　　要：目的探讨气道内喷洒利多卡因联合含服达克罗宁胶浆在支气管镜诊疗中的安全性和有效性。方法将2019年9月至2019年12月在福建省立医院接受支气管镜检查的100例患者,按随机数字表法分为两组:观察组50例,采用气道内喷洒利多卡因+含服达克罗宁胶浆局部麻醉;对照组50例,采用气道内滴注利多卡因+含服达克罗宁胶浆局部麻醉。记录各组在检查前、检查中(过声门后1 min)、检查结束时的心率、血压和血氧饱和度(SpO2)的变化,观察不良反应的发生情况,比较两组患者利多卡因用量的差别,并于检查后用视觉模拟评分(VAS)分别对患者和检查医师进行支气管镜检查的耐受性和满意度的评估。结果观察组利多卡因用量明显低于对照组(P<0.01),差异具有统计学意义。两组患者在各时点的心率、收缩压、舒张压、血氧饱和度差异无统计学意义。在不良反应的发生率上,包括重度高血压(收缩压>180 mmHg)、气管痉挛、低氧血症(SpO2<90%)等,两组患者差异无统计学意义。在检查后患者评估显示,观察组患者的咳嗽VAS评分显著低于对照组(P<0.05),而疼痛VAS评分两组差异无统计学意义(P>0.05);检查医师的评估显示,观察组患者的术中咳嗽和通过声门难易程度的VAS评分均显著优于对照组(P<0.05)。结论在局麻支气管镜检查中,气道内喷洒利多卡因联合含服达克罗宁胶浆可以减少利多卡因用量,并提高患者在检查过程中的耐受性和满意度。该方法安全可靠,有推广价值。Objective To discuss the efficacy and safety of intratracheal spraying of lidocaine combined with oral intake of dyclonine mucilage in flexible bronchoscopy.Methods A total of 100 patients receiving flexible bronchoscopy in Fujian Provincial Hospital from September 2019 to December 2019 were divided into two groups by means of a random number table.The trial group included 50 patients,receiving intratracheal spraying of lidocaine combined with oral intake of dyclonine mucilage for local anesthesia,while the control group of another 50 patients received intratracheal drip of lidocaine combined with oral intake of dyclonine mucilage.The heart rate,systolic blood pressure(SBP),diastolic blood pressure(DBP),and pulse oxygen saturation(SpO2)in each group were recorded at different points of time.The adverse events and dosage of lidocaine in each group during the bronchoscopy were also recorded.Moreover,the visual analogue scale(VAS)was used to assess the patient’s and doctor’s tolerance and satisfaction of the operation.Results The dosage of lidocaine in trial group was significantly lower than that in control group(P<0.01).The differences of heart rate,SBP,DBP,and SpO2 between the two groups showed no statistical significance(P>0.05).The differences of adverse events between the two groups,including severe hypertension(SBP>180 mmHg),bronchospasm and hypoxemia(SpO2<90%),showed no statistical significance(P>0.05).Compared with those in control group,patients in the trial group showed significantly lower VAS in cough(P<0.05).However,there was no significant difference in the degree of pain(P>0.05).The questionnaire for doctor showed that,the VAS of patient’s cough during the operation was significantly lower in trial group(P<0.05).Meanwhile,it was much more easier to pass the glottis for patients in trial groups than those in control group(P<0.05).Conclusion In flexible bronchoscopy under local anesthesia,intratracheal spraying of lidocaine combined with oral intake of dyclonine mucilage can reduce lidocaine dosag

关 键 词：支气管镜检查 气道内喷洒 利多卡因 达克罗宁 局部麻醉 

分 类 号：R768.1[医药卫生—耳鼻咽喉科]