天津医药

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静脉全麻置入喉罩吸氧下行支气管镜肺泡灌洗治疗的可行性

赵彤   

  1. 天津市胸科医院麻醉科
  • 收稿日期:2012-05-09 修回日期:2012-08-03 出版日期:2012-09-15 发布日期:2012-09-15
  • 通讯作者: 赵彤

  • Received:2012-05-09 Revised:2012-08-03 Published:2012-09-15 Online:2012-09-15

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摘要： 【摘要】目的 评价静脉全麻下置入喉罩吸氧行纤维支气管镜肺泡灌洗治疗的可行性。方法 拟行肺泡灌洗治疗患者60例，年龄45~59岁，随机分为局麻组（LA组，n=20）、静脉麻醉下面罩吸氧组（GA-M组，n=20）及静脉麻醉下置入喉罩吸氧组（GA-L组，n=20）。吸入2%利多卡因表面麻醉后，GA-L组及GA-M组行静脉全身麻醉，意识消失后，GA-L组置入喉罩，GA-M组给予面罩吸氧。静脉全麻下行纤维支气管镜检查及肺泡灌洗治疗，记录完成及苏醒时间，观察患者反应性症状如体动、呛咳、屏气、呼吸困难等发生情况，询问患者是否有痛苦记忆，记录内镜医师因患者反应性症状而中断操作的次数及肺泡灌洗液回收率。结果 与LA组相比，GA-L组及GA-M患者体动，呛咳发生率减少（P<0.05）。与GA-M组比较，GA-L组呼吸困难发生率降低（P<0.05）。与LA组比较，GA-M组及GA-L组患者痛苦记忆发生率显著降低（P<0.05）。内镜医师中断操作次数GA-L组及GA-M组相比LA组明显减少（P<0.05），GA-L组较GA-M组减少（P<0.05）。GA-L组及GA-M组肺泡灌洗液回收率较LA组提高（P<0.05）。结论　静脉全麻下置入喉罩吸氧可提高气管镜肺泡灌洗治疗效果及安全性，减少患者反应性症状，消除痛苦记忆。

关键词: 支气管镜, 肺泡灌洗, 喉面罩, 全身麻醉, 静脉

Abstract: 【Abstract】Objective To evaluate feasibility of bronchofibroscope alveolar wash therapy during intravenous anesthesia with laryngeal mask insertion. Methods 60 patients scheduled alveolar wash therapy, aged 45~59, were randomly divided into group LA(n=20), group GA-M(n=20) and group GA-L(n=20). After 2% lidocaine inhalation, patients in group GA-L and group GA-M anaesthetize by intravenous sedatives。Group GA-L inserted laryngeal mask，and group GA-M administrated face mask. Record completion time and awakening time. Observe the responsive symptom such as body movement, bucking, breathholding and dyspnea. Ask patients about the situations of painful memories. Record interrupt operation times and the lavage fluid recovery rate. Results Compared with group LA, there is lower body movement and bucking rate in group GA-L and group GA-M（P<0.05）. Compared with group GA-M, the incidence of dyspnea is lower in group GA-L（P<0.05）. Compared with group LA, the incidence of painful memories is lower in group GA-L and group GA-M（P<0.05）. Compared with group LA, interrupt operation times is significantly lower in group GA-L and group GA-M（P<0.05）,and that in group GA-L is lower than in group GA-M（P<0.05）. Compared with group LA, the lavage fluid recovery rate is higher in group GA-L and group GA-M（P<0.05）. Conclusion Bronchofibroscope alveolar wash therapy during intravenous anesthesia with laryngeal mask insertion can provide effective therapeutic efficacy ,increase safety, reduce the responsive symptom and decrease incidence of painful memories.

Key words: bronchoscope, alveolar wash, Laryngeal masks, general anaesthesia, intravenous