气管内表面麻醉联合全身麻醉在老年患者气管超声内镜引导针吸活检术中的应用  

Application of Intratracheal Topical Anesthesia Combined With General Anesthesia in Elderly Patients During the Procedure of Endobroncheal Ultrasound-guided Transbroncheal Needle Aspiration

作　　者：张永强 潘伟 姚兰 Zhang Yongqiang;Pan Wei;Yao Lan(Department of Anesthesiology, Peking University International Hospital, Peking 102206, China)

机构地区：[1]北京大学国际医院麻醉科,北京102206

出　　处：《中国微创外科杂志》2020年第9期834-837,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨气管内表面麻醉联合全身麻醉用于老年患者气管超声内镜引导针吸活检术(endobroncheal ultrasound-guided transbroncheal needle aspiration,EBUS-TBNA)的可行性和安全性。方法回顾性分析我院行EBUS-TBNA的老年患者(年龄65~85岁)63例,麻醉医生根据麻醉习惯选择麻醉方法,单纯全身麻醉31例(A组),气管内表面麻醉联合全身麻醉32例(B组)。比较EBUS-TBNA操作开始至苏醒拔除喉罩期间心血管不良事件(高血压、低血压、心律失常)发生的次数、呛咳/体动次数、苏醒时间(停止麻醉药物泵入至拔除喉罩时间)、瑞芬太尼用量和操作时间。结果B组患者心血管不良事件发生次数中位数2(0~3)次,明显少于A组6(3~12)次(Z=-6.758,P=0.000);B组患者呛咳/体动次数中位数0(0~1)次,明显少于A组2(0~4)次(Z=-4.943,P=0.000);B组患者瑞芬太尼用量(427.2±46.2)μg,明显少于A组(535.2±73.6)μg(t=6.996,P=0.000);B组患者苏醒时间(8.6±1.6)min,明显短于A组(12.4±1.9)min(t=8.855,P=0.000)。2组操作时间差异无显著性(32.7±3.9)min vs.(32.3±4.1)min(t=-0.362,P=0.719)。结论气管内表面麻醉联合全身麻醉用于老年患者EBUS-TBNA安全可行,与单纯全身麻醉相比术中循环系统更加稳定,苏醒更加迅速。Objective To observe the feasibility and safety for endobroncheal ultrasound-guided transbroncheal needle aspiration(EBUS-TBNA)under intratracheal topical anesthesia combined with general anesthesia in elderly patients.Methods A retrospective analysis was made on 63 elderly patients(65-85 years old)scheduled for EBUS-TBNA.They were divided into two groups according to the habit of the anesthesiologist to choose the mode of anesthesia,the group A(only received general anesthesia,n=31)and the group B(received intratracheal topical anesthesia combined with general anesthesia,n=32).All the patients had been recorded numbers of adverse cardiovascular events(hypertension,hypotension,arrhythmia)and cough/body motion,time of awake(the time from stopping the infusion of anesthetic drugs to the removal of laryngeal mask),remifentanil dosage,and operating time.Results The median number of adverse cardiovascular events in the group B was significantly lower than that in the group A[2(0-3)times vs.6(3-12)times,Z=-6.758,P=0.000].The number of cough/body motion in the group B was significantly lower than that in the group A[0(0-1)times vs.2(0-4)times,Z=-4.943,P=0.000].The remifentanil dosage in the group B was significantly less than that in the group A[(427.2±46.2)μg vs.(535.2±73.6)μg,t=6.996,P=0.000].The mean time of awake in the group B was significantly shorter than that in the group A[(8.6±1.6)min vs.(12.4±1.9)min,t=8.855,P=0.000].The operating time between the two groups was not statistically significant[(32.7±3.9)min vs.(32.3±4.1)min,t=-0.362,P=0.719].Conclusions The application of intratracheal topical anesthesia combined with general anesthesia during the procedure of EBUS-TBNA is safe and feasible in elderly patients.Compared with only general anesthesia,this combination anesthesia method has advantages of more stable hemodynamics and shorter time of awake.

关 键 词：气管内表面麻醉 环甲膜穿刺 全身麻醉 气管超声内镜引导针吸活检术 老年患者 

分 类 号：R61[医药卫生—外科学]