儿童舒适化支气管镜检查及支气管肺泡灌洗的临床观察

Clinical observation of comfortable bronchoscopy and bronchoalveolar lavage in children

摘要:

目的 探讨儿童支气管镜检查和支气管肺泡灌洗（BAL）的不同麻醉方式，并研究舒适化儿童支气管镜的临床使用方案。方法 选择郑州大学第一附属医院南院区（原河南省省立医院）2018年8月－2021年7月满足支气管镜检查和BAL临床适应证的住院患儿90例，按随机数表法将患儿分成观察组和对照组，纳入年龄1～3岁，各45例。观察组采用吸入加深度镇静和静脉复合麻醉，通过改良型双腔喉罩行支气管镜检查及BAL；对照组采用局部表面麻醉联合静脉麻醉支气管镜检查及BAL。记录并比较两组患儿术中不同时点各指标的变化情况。结果 观察组手术开始5 min（T₁）、15 min（T₂）、30 min（T₃）的经皮动脉血氧饱和度（SpO₂）、心率（HR）和平均动脉压（MAP）比较，差异均无统计学意义（P > 0.05）；对照组手术开始15 min（T₂）MAP与同时点观察组MAP比较，差异有统计学意义（P < 0.05）；观察组采用双腔改良型喉罩，平均操作时间短于对照组，躁动和呼吸道总不良反应较少，差异均有统计学意义（P < 0.05）。结论 吸入加深度镇静及静脉复合麻醉，通过改良型双腔喉罩进行支气管镜操作，较局部表面麻醉联合静脉麻醉躁动和呼吸道不良反应发生率低，MAP波动幅度小，手术时间短，且诊疗舒适化程度得到提升。

Abstract:

Objective To investigate the different anesthesia methods of bronchoscopy and bronchoalveolar lavage (BAL) in children, and study the clinical application of comfortable bronchoscopy in children.Methods 90 hospitalized children who met the bronchoscopy and BAL clinical indications from August 2018 to July 2021 were selected. The children were divided into observation group and control group according to random number table method, with 45 cases in each group aged 1 to 3 years. The observation group was treated with inhalation, deep sedation and intravenous anesthesia, bronchoscopy and BAL examination by modified double-cavity laryngeal mask. The control group received local surface anesthesia combined with intravenous anesthesia bronchoscopy and BAL. The changes of each index at different time points during operation were recorded and compared between the two groups.Results There was no statistically significant difference in percutaneous arterial oxygen saturation (SpO₂), heart rate (HR) and mean arterial pressure (MAP) at the start of surgery for 5 min (T₁) and 15 min (T₂) and 30 min (T₃) in the observation group (P > 0.05); MAP at the start of surgery for 15 min (T₂) in the control group was compared with the MAP in the observation group, there was a significant difference (P < 0.05). The observation group was given a modified laryngeal mask with two cavities, the average operation time of the observation group was shorter than that of the control group, agitation and the total adverse respiratory reactions were less in the observation group, and the differences were statistically significant (P < 0.05).Conclusion Compared with local surface anesthesia combined with intravenous anesthesia, the incidence of agitation and adverse respiratory reactions were lower during bronchoscopy by inhalation combined with deep sedation and intravenous anesthesia, MAP fluctuation was smaller, operation time was shortened, and the degree of diagnosis and treatment comfort was improved.