喉麻管喷洒利多卡因联合喉罩全麻用于支气管镜活检术的有效性及安全性  

Efficacy and safety of laryngeal anesthesia tube spraying lidocaine combined with laryngeal mask general anesthesia for bronchoscopy biopsy

作　　者：周颖 汪雅琴 邵杰 杭博 黄静 ZHOU Ying;WANG Yaqin;SHAO Jie;HANG Bo;HUANG Jing(Painless Comfort Medical Center,Ordnance Industry Hygiene Institute/Norinco General Hospital,Xi'an 710065,China;Respiratory and Critical Care Medicine Department,Ordnance Industry Hygiene Institute/Norinco General Hospital,Xi'an 710065,China)

机构地区：[1]兵器工业卫生研究所/兵器工业总医院无痛舒适化医疗中心,陕西西安710065 [2]兵器工业卫生研究所/兵器工业总医院呼吸与危重症医学科,陕西西安710065

出　　处：《临床医学研究与实践》2025年第4期53-57,共5页Clinical Research and Practice

基　　金：陕西省重点研发计划项目(No.2024SF-YBXM-096);兵器工业卫生研究所2024年度科技开发费项目(所科字[2024]129号-7)。

摘　　要：目的观察喉麻管喷洒利多卡因联合喉罩全麻用于支气管镜活检术的有效性及安全性。方法选择2023年1月至6月在本院择期行支气管镜活检术的120例患者为研究对象,按随机数字表法将其分为Ⅰ组(40例,内镜通道滴注利多卡因联合静脉镇静)、Ⅱ组(40例,内镜通道滴注利多卡因联合喉罩全麻)和Ⅲ组(40例,可视喉镜下喉麻管喷洒利多卡因联合喉罩全麻)。比较三组的麻醉效果。结果三组的支气管镜活检检查时间比较,差异无统计学意义(P>0.05)。Ⅱ组和Ⅲ组术中高血压、心动过速及低氧血症发生率低于Ⅰ组,差异具有统计学意义(P<0.05)。Ⅲ组的术中呛咳、术中体动和苏醒期咳嗽发生情况优于Ⅰ组和Ⅱ组,差异具有统计学意义(P<0.05)。Ⅲ组的依丙混合液用量少于Ⅰ组,差异具有统计学意义(P<0.05);Ⅱ组的瑞芬太尼用量多于Ⅰ组,差异具有统计学意义(P<0.05);Ⅲ组的依丙混合液、瑞芬太尼和米库氯铵用量少于Ⅱ组,差异具有统计学意义(P<0.05)。表面麻醉后15 min(T1)、表面麻醉后30 min(T2),Ⅲ组的血浆利多卡因浓度高于Ⅰ组和Ⅱ组,差异具有统计学意义(P<0.05)。Ⅲ组T2时血浆利多卡因浓度在1~<2μg/mL有18例(45.00%),在2~<3μg/mL有21例(52.50%),在3~4μg/mL有1例(2.50%)。结论喉麻管喷洒利多卡因联合喉罩全麻用于支气管镜活检术能有效调控心血管应激反应,抑制术中呛咳和苏醒期咳嗽,且安全性较高,值得临床进一步推广和应用。Objective To observe the efficacy and safety of laryngeal anesthesia tube spraying lidocaine combined with laryngeal mask general anesthesia for bronchoscopy biopsy.Methods A total of 120 patients who underwent scheduled bronchoscopy biopsy in our hospital from January to June 2023 were selected as the research objects.According to the random number table method,the patients were divided into groupⅠ(40 cases,endoscopic channel infusion of lidocaine combined with intravenous sedation),groupⅡ(40 cases,endoscopic channel infusion of lidocaine combined with laryngeal mask general anesthesia)and groupⅢ(40 cases,visual laryngoscope laryngeal anesthesia tube spraying of lidocaine combined with laryngeal mask general anesthesia).The anesthetic effects of the three groups were compared.Results There was no significant difference in the time of bronchoscopy biopsy among the three groups(P>0.05).The incidence of hypertension,tachycardia and hypoxemia in the groupⅡand the groupⅢwere lower than those in the groupⅠ,and the differences were statistically significant(P<0.05).The incidences of intraoperative cough,intraoperative body movement and cough during recovery period in the groupⅢwere better than those in the groupⅠand the groupⅡ,and the differences were statistically significant(P<0.05).The dosage of etomidate and propofol mixed solution in the groupⅢwas less than that in the groupⅠ,and the difference was statistically significant(P<0.05);the dosage of remifentanil in the groupⅡwas more than that in the groupⅠ,and the difference was statistically significant(P<0.05);the dosage of etomidate and propofol mixed solution,remifentanil and mivacurium chloride in the groupⅢwere less than those in the groupⅡ,and the differences were statistically significant(P<0.05).At 15 min after topical anesthesia(T1),30 min(T2)after topical anesthesia,the plasma lidocaine concentration in the groupⅢwas higher than that in the groupⅠand the groupⅡ,and the difference was statistically significant(P<0.05).In

关 键 词：支气管镜活检术 喉罩 全麻 表面麻醉 利多卡因 

分 类 号：R614[医药卫生—麻醉学]