改良人工气道在支气管镜介入治疗中的应用研究

目的 探讨自制支气管镜导管——改良人工气道在支气管镜介入治疗中的安全性及有效性.方法 将126例患者分为3组:常规支气管镜检查治疗组(常规组)、无痛支气管镜介入治疗组(无痛组)及经改良人工气道下行无痛支气管镜介入治疗组(改良组).3组患者均先予2％利多卡因5 mL雾化吸入行表面麻醉,建立静脉通道,多参数心电监护仪监测血压、呼吸、心率及指氧饱和度.无痛组(n=40)患者在常规组(n=45)基础上术前静脉推注咪达唑仑0.06 mg/kg和芬太尼1 μg/kg,改良组(n=41)在无痛组基础上以支气管镜引导经口腔置入改良人工气道,然后经改良人工气道进行支气管镜检查和治疗.3组患者皆测定术前及术中的血压、心率,然后计算其波动值.观察患者体动、短暂呼吸抑制情况及术后感受、反应,同时对医师操作过程的便捷程度进行评估.结果 无痛组血压较术前有所下降,改良组血压波动值与常规组无明显差异(P＞0.05).3组术中心率皆有所上升,常规组与改良组比较无明显差异(P＞0.05).无痛组、改良组患者体动情况及术后痛苦记忆少于常规组(P＜0.05).3组患者出现呼吸抑制情况无明显差异(P＞0.05).医师操作过程中的便捷程度及舒适感改良组优于常规组和无痛组(P＜0.05).结论经改良人工气道在支气管镜介入治疗操作安全性与常规支气管检查治疗相当,但其术中体动及术后痛苦记忆明显少于常规支气管镜检查,医师操作过程中的便捷程度及舒适感明显优于常规支气管镜检查治疗组,值得临床推广应用.

Application of Improved Artificial Airway in Interventional Therapy with Bronchoscope

Objective To investigate the safety and effectiveness of a self-made bronchoscopic catheter （an improved artificial airway ） in bronchoscopic interventional therapy. Methods 126 patients planning to receive bronchoscope between October 2012 and February 2013 were divided into A, B and C groups. Three groups received inhalation of 2% lidocaine 5mL for surface anesthesia, and the venous channel was build up. Then the patients in group A （ n = 45 ） were treated with conventional bronchoscope. The patients in group B （n = 40 ） were treated with painless bronchoscope （received intravenous injection with midazolam 0. 06 mg/kg and fentanyl 1μg/kg before operation）. The patients in group C （n = 41 ） were treated with painless bronchoscope through improved artificial airway （ after anesthesia similar to group B, the improved artificial airway was implanted through the mouth guided by bronchoscope, then the bronchoscopy was performed through artificial airway）. Blood pressure, respiration rate, heart rate and the pulse oxygen saturation were measured by multi-parameter ECG monitor before and during the operation, and the differences were compared among three groups. Body movement, transient respiratory depression during the operation, and postoperative feelings and reactions after operation were also observed. Meanwhile, the convenience of operation by physicians was evaluated. Results The blood pressure fluctuations in group C and group A had no significant difference （ P 〉 0. 05 ）. Heart rate of three groups was somewhat increased,but there was no significant difierence between group C and group A （ P 〉 0. 05）. Body movement and postoperative pain memoly in group B and group C were better than those in group A （P 〈 0.05）. Respiratory depression of three groups had no significant difference （ P 〉 0. 05 ）. The operative convenience and the cumtbrt of physicians in group C were better than those in group A and group B （ P 〈 O. 05）. Conclusions Operation s~ffety of bronchoscopic interventional treatment with improved artificial airway is similar to the conventional procedure, but the reaction of the intra-operation and postoperative painful memories are significantly superior to conventional bronchoscopy. The convenience of operation and eomiort of physicians are much better than the conventional bronchoscopy. It can be concluded that the improved artificial airways is worthy of clinical applieation.