支气管镜诊疗操作前利多卡因雾化吸入麻醉有效性的随机对照研究  

A randomized controlled study on the effectiveness of lidocaine inhalation anesthesia before bronchoscopic diagnosis and treatment

作　　者：饶振译 杨涵 李婷 李锦 李燕青 张茜 李璇 Rao Zhenyi;Yang Han;Li Ting;Li Jin;Li Yanqing;Zhang Xi;Li Xuan(Department of Respiratory and Critical Care Medicine,Gejiu People′s Hospital,Gejiu 661000,China)

机构地区：[1]个旧市人民医院呼吸与危重症医学科,个旧661000

出　　处：《国际呼吸杂志》2023年第3期310-316,共7页International Journal of Respiration

基　　金：云南省教育厅科学研究基金教师类项目 (2022J0275)。

摘　　要：目的探讨是否必要在支气管镜诊疗操作前进行利多卡因雾化吸入麻醉。方法本研究为完全随机设计,将2020年4月1日至2021年12月31日个旧市人民医院呼吸与危重症医学科进行支气管镜诊疗操作的279例患者,按随机数字表法分为利多卡因组133例,生理盐水组146例。2组均使用咪达唑仑+舒芬太尼进行镇静镇痛,记录2组患者一般情况(性别、年龄、体质量指数);利多卡因、咪达唑仑、舒芬太尼用量;操作前5 min,操作开始5 min、10 min、15 min和操作结束时生命体征变化(心率、呼吸、收缩压、舒张压和脉搏血氧饱和度),并使用视觉模拟评分(VAS)分别针对患者和操作医师进行评分。结果剔除不配合完成VAS评分者后,共纳入229例进行统计分析(利多卡因组113例,生理盐水组116例)。2组患者一般情况(性别、年龄、体质量指数)差异均无统计学意义(均P>0.05);利多卡因组和生理盐水组利多卡因、咪达唑仑和舒芬太尼用量分别为(205±47)mg比(206±42)mg、(2.3±1.8)mg比(2.4±1.8)mg、(5.1±1.1)μg比(5.1±1.1)μg,差异均无统计学意义(t值分别为0.15、0.24和0.10,均P>0.05)。2组检查类别、患者和操作医师VAS评分差异均无统计学意义(均P>0.05)。2组患者操作前5 min,操作开始5 min、10 min、15 min和操作结束时生命体征(心率、呼吸、收缩压、舒张压、脉搏血氧饱和度)组间差异均无统计学意义(均P>0.05);2组心率、呼吸、收缩压、舒张压、脉搏血氧饱和度在时点间差异均有统计学意义,分别为心率(F=23.68,P=0.001),呼吸(F=5.48,P=0.001),收缩压(F=9.02,P=0.001),舒张压(F=3.52,P=0.008),脉搏血氧饱和度(F=8.90,P=0.001)。2组舒张压、脉搏血氧饱和度在组间·时点间交互作用差异均有统计学意义,分别为舒张压(F=3.09,P=0.017),脉搏血氧饱和度(F=3.11,P=0.016)。结论在支气管镜诊疗操作前进行利多卡因雾化吸入麻醉无必要。Objective To investigate the necessity of lidocaine inhalation anesthesia before bronchoscopy.Methods It was a completely randomized study involving 279 patients who underwent bronchoscopic diagnosis and treatment in the Department of Respiratory and Critical Care Medicine of Gejiu People′s Hospital from April 1,2020 to December 31,2021.They were randomly assigned to the lidocaine group(n=133)and the saline saline group(n=146).Midazolam and sufentanil were used in both groups for sedation and analgesia.The general conditions,including the gender,age and body mass index(BMI)were recorded.The dosage of lidocaine,midazolam and sufentanil,and vital signs at 5 min before bronchoscopy,5 min,10 min,15 min after bronchoscopy and at the end of the bronchoscopy were recorded,including the heart rate,respiration,systolic blood pressure(SBP),diastolic blood pressure(DBP)and pulse oxygen saturation(SpO_(2)).The visual analogue scale(VAS)was performed in the patients and the operating physicians.Results After excluding those who did not cooperate to complete the assessment of VAS,229 eligible ones were recruited,including 113 cases in lidocaine group and 116 cases in saline group.There were no significant differences in general conditions(gender,age,BMI)between the two groups(all P>0.05).The dosage of lidocaine(205±47 mg vs 206±42 mg,t=0.15),midazolam(2.3±1.8 mg vs 2.4±1.8 mg,t=0.24)and sufentanil(5.1±1.1μg vs 5.1±1.1μg,t=0.10)was comparable between lidocaine group and saline group(all P>0.05).There were no significant differences in the types of operation,VAS scores of patien and operating physicians,vital signs(heart rate,respiration,SBP,DBP,SpO_(2))at 5 min before bronchoscopy,5 min,10 min,15 min after bronchoscopy and at the end of the bronchoscopy between groups(all P>0.05).There were significant differences in all vital signs,including heart rate(F=23.68,P=0.001),respiration(F=5.48,P=0.001),SBP(F=9.02,P=0.001),DBP(F=3.52,P=0.008),and SpO_(2)(F=8.90,P=0.001)at all time points.There were significant differences i

关 键 词：支气管镜检查 利多卡因 雾化吸入 麻醉 

分 类 号：R614[医药卫生—麻醉学]