改良无痛纤维支气管镜检查在老年人中的应用

目的探讨改良无痛纤维支气管镜检查用于老年人的安全性及可行性。方法 90例患者,其中男性49例,女性41例;年龄30～85岁,平均年龄63岁。随机分为A组(≥65岁)、B组(≥65岁)及C组(<65岁)。A组予2%利多卡因氧气加压雾化吸入;B、C组予阿托品及2%利多卡因氧气加压雾化吸入,术前30 min缓慢静脉注射曲马多50～100 mg及地西泮0.1 mg/kg(5～10mg),3组术中予以利多卡因间断气管内滴入。观察检查前、中、后的血压、心率、呼吸频率、血氧饱和度变化,询问术中、术后咽部不适、喉痉挛、咳嗽、胸部不适、头晕、乏力、不良回忆等不良反应及愿意接受再次检查、遗忘度、满意度等问题。结果 A组患者在纤维支气管镜检查过程中血压、心率均明显升高,呼吸增快,氧饱和度减低,与检查前、后及B组比较差异有统计学意义(P<0.05)。B组患者镜检中血压、心率、呼吸频率有所升高,氧饱和度略减低,较检查前、后及C组比较差异无统计学意义(P>0.05)。入声门时同检查前的心率变化B组较C组小,差异有统计学意义(P<0.05)。A组发生不良反应多,术后满意度低,大都表示不能接受下次操作,与B组比较差异有统计学意义(P<0.05);B、C组患者的不良反应及术后评价差异无统计学意义(P>0.05)。结论改良无痛纤维支气管镜检查用于老年人效果满意,是安全、可行的。

Application of modified painless fibrobronchoscopy in the elderly

Objective To explore the safety and feasibility of modified painless fibrobronchoscopy in the elderly.Methods Ninety patients were enrolled,male 49,female 41,aged 30-85 years old,mean age 63 years old.They were randomly divided into groups A,B and C.The group A(≥ 65-year-old) was lidocaine surface anesthesia group,group B(≥ 65-year-old) and group C(< 65-year-old): lidocaine and atropine local anesthesia combined tramadol and diazepam intravenous group.Group A inhaled 2 % lidocaine aerosol with oxygen pressure.Group B and group C inhaled atropine and 2 % lidocaine aerosol with oxygen pressure;Preoperative 30-minute,group B and group C were used tramadol 50-100 mg and diazepam 0.1 mg/kg(5-10 mg) intravenously.During the operation,3 groups were dripped lidocaine into bronchus discontinuously.The blood pressure,heart rate,breathe rate and oxygen saturation before,during and after the operation were observed.Their adverse reactions such as laryngospasm,cough,pain,feeble,dizziness,during and after the operation were enquired.Then the operation experience,satisfactory and patients willing to re-examination were recorded.Results In the process of fibrobronchoscopy,blood pressure and heart rate of group A were significantly increased,breathing added fast and oxygen saturation was reduced.The differences compared with the data of group B and before and after the operation of group A had statistical significance(P < 0.05).During the operation,the blood pressure,heart rate,and breathing of group B were slightly increased,oxygen saturation was reduced slightly.The differences compared with the data of group C and before and after the operation of group B had no obvious difference(P > 0.05).Into the subglottic,compared with group B and C,the changes of heart rate had statistical significance(P < 0.05).There was more bad memory after the operation in group A.Nevertheless,most patients in group B and C were willing to accept another operation and satisfied with the operation(P < 0.05).Conclusion It is demonstrated that the modified painless fibrobronchoscopy for elderly is safety and feasibility.