不同麻醉方式用于支气管镜诊疗的临床观察

Clinical observation of different anesthesia methods for bronchoscope

摘要:

目的 观察不同麻醉方式用于支气管镜诊疗的不良反应发生情况，旨在为临床选择最佳麻醉方式提供思路。方法 选择2022年6月－2023年6月于该院行支气管镜诊疗的患者150例，按随机数表法分为W组（雾化吸入利多卡因联合静脉镇静）、Q组（喉罩全身麻醉）和H组（喉麻管喷洒利多卡因联合全身麻醉），每组各50例。记录不同时点患者心率（HR）、平均动脉压（MAP）和经皮动脉血氧饱和度（SpO₂），记录苏醒期不良反应、苏醒时间和麻醉药物用量。结果 T₁和T₂时点，W组SpO₂为（89.4±0.7）%和（91.8±0.3）%，明显低于T₀时点的（99.6±0.8）%，且低于Q组的（98.6±1.3）%和（98.5±1.6）%，以及H组的（99.7±0.3）%和（98.4±1.6）%，差异均有统计学意义（P < 0.05）；T₁和T₂时点，W组MAP为（108.5±7.8）和（105.6±7.3）mmHg，明显高于T₀时点的（87.5±8.6）mmHg，且高于Q组的（92.6±8.5）和（85.8±11.3）mmHg，以及H组的（85.7±9.2）和（85.2±10.8）mmHg，差异均有统计学意义（P < 0.05）；T₁和T₃时点，Q组MAP为（92.6±8.5）和（91.4±8.6）mmHg，高于T₀时点的（87.8±7.5）mmHg，且高于H组的（85.7±9.2）和（86.5±7.2）mmHg，差异均有统计学意义（P < 0.05）；T₁和T₂时点，W组HR为（92.7±9.6）和（91.3±9.2）次/min，高于T₀时点的（72.3±8.4）次/min，且高于Q组的（75.3±11.6）和（78.5±12.8）次/min，以及H组的（76.6±10.7）和（77.2±8.5）次/min，差异均有统计学意义（P < 0.05）。Q组苏醒期低氧血症、心律失常和咳嗽发生率高于W组和H组，差异均有统计学意义（P < 0.05）。H组苏醒时间为（11.5±7.2）min，明显短于W组的（16.8±8.5）min和Q组的（17.6±6.4）min，差异均有统计学意义（P < 0.05）；H组丙泊酚用量为（314.3±12.7）mg，瑞芬太尼用量为（211.6±12.5）μg，少于W组的（390.5±12.4）mg和（268.4±13.6）μg，以及Q组的（387.6±15.2）mg和（372.5±15.3）μg，差异均有统计学意义（P < 0.05）；H组米库氯铵用量为（23.7±3.8）mg，少于Q组的（32.5±4.3）mg，差异有统计学意义（P < 0.05）。结论 喉麻管喷洒利多卡因联合全身麻醉用于支气管镜诊疗术，利于呼吸管理，且围手术期不良反应少，是最佳麻醉方式。

Abstract:

Objective To observe the adverse reactions of different anesthesia methods used in bronchoscopic diagnosis and treatment, and provide ideas for clinical selection of the best anesthesia methods.Methods 150 patients from June 2022 to June 2023 for bronchoscope were randomly divided into group W (atomization with lidocaine combined with intravenous sedation), group Q (laryngeal mask general anesthesia) and group H (lidocaine sprayed by laryngeal anesthetic tube combined with general anesthesia), with 50 cases in each group. Heart rate (HR), mean arterial pressure (MAP) and percutaneous arterial oxygen saturation (SpO₂) values were recorded at different time points, adverse reactions during recovery, recovery time and dosage of anesthetic drugs were recorded.Results At T₁ and T₂, SpO₂ in group W (89.4 ± 0.7)% and (91.8 ± 0.3)% were lower than that (99.6 ± 0.8)% in T₀, and lower than those (98.6 ± 1.3)% and (98.5 ± 1.6)% in group Q and (99.7 ± 0.3)% and (98.4 ± 1.6)% in group H, the difference were statistically significant (P < 0.05). At T₁ and T₂, the MAP of group W were (108.5 ± 7.8) and (105.6 ± 7.3) mmHg, which were significantly higher than those of T₀ (87.5 ± 8.6) mmHg, and higher than those of group Q (92.6 ± 8.5) and (85.8 ± 11.3) mmHg, respectively, higher than those (85.7 ± 9.2) and (85.2 ± 10.8) mmHg in group H, the differences were statistically significant (P < 0.05). The MAP of group Q at T₁ and T₃ was (92.6 ± 8.5) and (91.4 ± 8.6) mmHg, respectively, higher than that of T₀ (87.8 ± 7.5) mmHg, and higher than those of group H (85.7 ± 9.2) and (86.5 ± 7.2) mmHg, with statistical significance (P < 0.05). At T₁ and T₂, the HR of group W was (92.7 ± 9.6) and (91.3 ± 9.2) times/min, higher than that of T₀ (72.3±8.4) times /min, and higher than those of group Q (75.3 ± 11.6) and (78.5 ± 12.8) times /min, respectively, and higher than those of group H (76.6 ± 10.7) and (77.2 ± 8.5) times /min, and the differences were statistically significant (P < 0.05). The hypoxemia, arrhythmia and cough rates in group Q were higher than those in group W and group H, and the differences were statistically significant (P < 0.05). The recovery time of group H was (11.5 ± 7.2) min, which was significantly lower than that of group W (16.8 ± 8.5) min and group Q (17.6 ± 6.4) min, and the differences were statistically significant (P < 0.05). The dosage of propofol in group H was (314.3 ± 12.7) mg and remifentanil was (211.6 ± 12.5) μg, both lower than those in group W (390.5±12.4) mg and (268.4 ± 13.6) μg, and lower than those in group Q (387.6 ± 15.2) mg and (372.5 ± 15.3) μg. The differences were statistically significant (P < 0.05). The dosage of micuronium chloride was (23.7 ± 3.8) mg in group H, lower than (32.5 ± 4.3) mg in group Q, and the difference was statistically significant (P < 0.05).Conclusion Lidocaine sprayed by laryngeal anesthetic tube combined with general anesthesia is the best anesthesia method for bronchoscopic diagnosis and treatment, which is beneficial to respiratory management and less adverse reactions in perioperative period.