表面麻醉在喉罩无痛纤维支气管镜检查中的应用价值

①目的评价表面麻醉在喉罩无痛纤维支气管镜检查中的应用价值。②方法 40例行纤维支气管镜检查患者,随机分为两组（n=20）：利多卡因复合喉罩组（A组）和喉罩组（B组）。A组患者入室后对其咽喉部进行表面麻醉,然后进行麻醉诱导插入喉罩。B组不用表面麻醉,直接进行麻醉诱导插入喉罩。记录喉罩插入前（T0）、插入后即刻（T1）、经纤维支气管镜活检或刷检时（T2）、拔出喉罩时（T3）的SBP、HR;每例患者芬太尼、丙泊酚总用量;分别在患者拔喉罩后5、60min统计咽喉疼痛、声音嘶哑、呛咳例数。③结果 A组患者各时点的SBP、HR与同组T0比较无统计学意义（P〉0.05）;而B组各时点的SBP、HR均比同组T0显著升高（P〈0.05）。A组患者在各时的SBP、HR明显低于B组同时点（P〈0.05）。A组患者的丙泊酚和芬太尼用量比B组减少,差异有统计学意义（P〈0.05）;A组患者拔喉罩后5min咽喉疼痛及呛咳较B组显著减少,差异有统计学意义（P〈0.05）;而拔喉罩后60min咽喉疼痛、声音嘶哑及呛咳例数两组无统计学差异（P〉0.05）。④结论在喉罩无痛纤维支气管镜检查中加用表面麻醉,患者的血流动力学更趋平稳,麻醉用药量减少,可以明显降低术后不适反应。

Application of topical anesthesia in bronchofiberscopy with proseal laryngeal mask

Objective To evaluate the application of topical anesthesia in bronchofiberscopy with laryngeal mask.Methods 40 patients presenting bronchofiberscopy were randomly assigned to laryngeal mask combined lidocaine group（Group A,n = 20） and laryngeal mask group（Group B,n = 20）.Patients in group A received pars laryngea pharyngis topical anesthesia before general anesthesia induction,and lidocaine was injected to vocal cords,trachea and bronchus via bronchofiberscope during bronchofiberscopy.Patients in group B received general anesthesia without topical anesthesia.SBP and HR were recorded at the time of before laryngeal mask insertion（T0）,after laryngeal mask insertion（T1）,getting specimen via bronchofiberscope（T2） and laryngeal mask extraction（T3）.The consumption of propofol and fentanyl were recorded too,and the incidence of sore throat,hoarseness and bucking after laryngeal mask extraction 5 and 30 min were recorded respectively.Results SBP and HR showed no statistic difference between each time and T0 in group A（P ＆gt; 0.05）,whereas SBP and HR at each time point was higher than T0 in group B（P ＆lt; 0.05）.SBP and HR in group A was significantly lower than group B at each point（P ＆lt; 0.05）.The consumption of propofol and fentanyl in group A was significantly lower than group B（P ＆lt; 0.05）.The incidence of sore throat and bucking in group A after laryngeal mask extraction 5 min was significantly lower than group B（P ＆lt; 0.05）,however there was no significantly difference between the two groups in the incidence of sore throat,hoarseness and bucking after laryngeal mask extraction 60min（P ＆gt; 0.05）.Conclusion Application of topical anesthesia during bronchofiberscopy with laryngeal mask can provid more stable hemodynamics,reduce the consumption of anesthetics,and obviously decrease the incidence of adverse reactions after the procedure.This way possess a higher Clinical using value.