摘要目的 探讨局部麻醉基础上镇痛镇静支气管镜检查(简称无痛支气管镜检查)的安全性和有效性.方法 比较2016年6月至2017年12月在北京协和医院呼吸与危重症医学科由同一技师辅助完成的无痛支气管镜检查患者(研究组,314例)、局部麻醉支气管镜检查患者(对照组,1166例)的特点、术中监测指标及术后问卷调查项目.结果 研究组>60岁的患者比例高于对照组(51.3％比41.4％,χ2=10.5,P<0.001).研究组心脏、中枢神经系统等基础疾病多于对照组.研究组麻醉所需时间长于对照组[(20.3±9.7)min比(11.6±3.1)min,t=15.7,P<0.001].研究组术中收缩压[(9.5±3.1)mmHg比(30.6±17.1)mmHg(1 mmHg=0.133 kPa),t=-39.8,P<0.001]、心率[(5.2±2.3)次/min比(25.2±15.1)次/min,t=-43.4,P<0.001]及指氧饱和度[(1.1±0.2)％比(12.7±5.3)％,t=-74.5,P<0.001]的变化低于对照组.研究组肿物/支气管黏膜活检(54.1％比35.2％,χ2=37.0,P<0.001)、支气管冲洗(48.7％比35.2％,χ2=19.1,P<0.001)、经支气管镜针吸活检(22.9％比0.3％,χ2=264.3,P<0.001)、经支气管镜取异物及镜下介入治疗(3.5％比0.09％,χ2=31.8,P<0.001)等操作多于对照组,经支气管镜肺活检(3.2％比27.8％,χ2=85.7,P<0.001)、支气管肺泡灌洗(17.5％比25.5％,χ2=8.6,P=0.003)则少于对照组.对照组患者术后咽痛(93.5％ 比85.6％,χ2=6.3,P=0.012)及术中窒息感(92.2％比2.9％,χ2=226.3,P<0.001)的发生率高于研究组,研究组接受再次支气管镜检查的比例(86.5％比9.6％,χ2=228.7,P<0.001)、术后嗜睡(77.9％比18.9％,χ2=122.9,P<0.001)、乏力(64.4％比19.6％,χ2=74.6,P<0.001)的发生率高于对照组.结论 无痛支气管镜检查术中生命体征参数、指氧饱和度波动小,增加了患者的舒适度和依从性,扩大了支气管镜操作的受试者人群,为复杂的气管镜下操作提供了方便.

abstractsObjective To investigate the safety and efficacy of the sedation based on topical anesthesia during flexible bronchoscopic procedure.Methods Patients who were performed with flexible bronchoscopy in the Department of Respiratory and Critical Care Medicine,Peking Union Medical College Hospital from June 2016 to December 2017 were enrolled in the study.All these bronchoscopic procedures were assisted with the same technician.The patients who underwent topical anesthesia with nebulized lidocaine were defined as the control group (n =1166),and those who were performed with sedation by combination using of benzodiazepines and opiates based on the topical anesthesia with nebulized lidocaine were defined as the study group (n =314).The clinical characters,the difference of vital signs during the brochoscopic procedure,the questionnaire about&nbsp;the patient′s satisfaction,and discomforts after the procedure were compared between the study group and the control group.Results Patients who were older than 60 years old in the study group were more than those in the control group (51.3％ vs 41.4％,χ2 = 10.5,P < 0.001).Patients with cardiac and/or central nervous diseases in the study group were more than those in the control group.The anesthesia duration in the study group was longer than that in the control group[(20.3± 9.7) min vs (11.6 ± 3.1) min ,t = 15.7,P <0.001].According to the surveillance during the bronchoscopic procedure,the difference of systolic blood pressure [(9.5 ±3.1) mmHg vs (30.6 ± 17.1) mmHg (1 mmHg=0.133 kPa),t =-39.8,P <0.001],heart rate [(5.2 ±2.3) bpm vs (25.2±15.1) bpm,t = -43.4,P <0.001] and oxygen saturation [(1.1 ± 0.2)％ vs (12.7 ± 5.3)％,t =-74.5,P <0.001] in the study group were lower than those in the control group. The biopsies for the mass and/or the involved bronchial mucosa(54.1％ vs 35.2％,χ2 =37.0,P <0.001),bronchial aspiration (48.7％ vs 35.2％,χ2 = 19.1,P < 0.001),transbronchial needle aspiration(22.9％ vs 0.3％,χ2 = 264.3,P < 0.001) and interventional procedures (3.5％ vs 0.09％,χ2=31.8,P <0.001)were performed more in the study group compared with the control group.And transbronchial lung biopsy (3.2％ vs 27.8％,χ2 = 85.7, P < 0.001) and bronchoalveolar lavage(17.5％ vs 25.5％,χ2 =8.6,P =0.003)were performed less in the study group compared with the control group.The incidences of throat pain(93.5％ vs 85.6％,χ2=6.3, P =0.012) and choking-like sensation(92.2％ vs 2.9％,χ2 =226.3,P <0.001) in the control group were higher than those in the study group.But the willingness to undergo a repeat future bronchoscopic procedure (86.5％ vs 9.6％,χ2 = 228.7,P < 0.001),the incidences of sleepy (77.9％ vs 18.9％,χ2 = 122.9,P < 0.001) and fatigue (64.4％ vs 19.6％,χ2 = 74.6,P <0.001) after bronchoscopy in the study group were higher than those in the control group. Conclusions Using sedation based on topical anesthesia can reduce the difference of vital sign parameters and oxygen saturation during the bronchoscopic procedure,ameliorate patients′discomfort,improve their tolerance,and perform more complicated interventional procedures.