静脉维持丙泊酚全麻加口咽通气管行无痛支气管镜检查的临床应用

目的探讨一种方便、有效、安全的支气管镜麻醉方法，配合支气管镜的临床应用。方法研究组169例患者以芬太尼诱导后丙泊酚微泵静脉维持，达全麻状态下经口放置口咽通气管吸氧行无痛性纤维支气管镜。观察过程中患者的反应性症状，询问患者的痛苦记忆以及医生操作情况，并与同期256例对照组进行比较；记录研究组生命体征变化，评价该方法的安全性。结果研究组169例患者共进行236次支气管镜操作，成功率100％。与对照组比较，操作过程中体动、呛咳、屏气、呼吸困难等反应性症状均较低（P〈0．01）；患者痛苦记忆少（P〈0．01），医生操作完成到位程度高。研究组操作全过程患者无任何不适感觉，生命体征稳定。结论静脉雏持全麻加用口咽通气管吸氧行无痛支气管镜，是一种痛苦少、反应轻、操作容易、安全可行的麻醉方法，尤其适用需要多次检查治疗的患者。

Bronchoscope performing under anesthesia of intravenously maintained propofol added with oropharynx breather

Objective To explore a convenient, effective and safe anesthetic method in bronchoscope and promote further clinical application of bronchoscope. Methods In study group, 169 patients were intravenously injected with fentanyli and maintained with propofol in mini-pump to approach the general anesthetic state, followed by insertion with oropharynx breather for oxygen inspiration orally. The reactive symptoms were observed during the operation and the memory of pain was inquired after every process, the performance and targeting extent by the operator were evaluated, and compared with 256 patients in control group in the same period. The main life signs changes were recorded to evaluate the safety of this anesthetic method. Results In study group, the operations were performed 236 times on 169 patients, and the success rate was 100%. Compared with control group, the reactive symptoms such as body maneuver, bucking, breath-holding, hard-breathing were lower ( P<0.01), and the memory of pain was less ( P<0.01). In study group, the targeting extent achieved higher. The patients in study group reported no uncomfortable sensation, and their main life signs were stable. Conclusion Intravenously maintained general anesthesia added with oropharynx breather for oxygen inspiration to perform bronchoscope offers a non-pain, less-symptomatic, easy targeting, relative safe anesthetic method in clinical use, and is especially suitable for patients who need operate bronchoscope repeatedly.