| 摘要: |
| ［摘要］ 目的 观察丁卡因明视下气管内表面麻醉联合喉罩全麻用于支气管镜检查的临床效果。方法 招募2024年6月至12月在兵器工业总医院择期行支气管镜检查的患者160例，采用随机数字表法将其分为观察组（采用丁卡因明视下气管内表面麻醉联合喉罩全麻）和对照组（采用利多卡因明视下气管内表面麻醉联合喉罩全麻），每组80例。比较两组麻醉前（T0）、检查开始后1 min（T1）、检查开始后5 min（T2）和取出喉罩后2 min（T3）的心率（HR）、平均动脉压(MAP)和脉搏血氧饱和度(SpO2)水平。比较两组检查中呛咳评分、苏醒期咳嗽评分和气道发痒发生率以及依托咪酯丙泊酚混合液和瑞芬太尼的用量。记录苏醒期不良反应发生情况。结果 在T0～T3时间点，观察组SpO2、MAP和HR水平均无显著变化（P>0.05）；对照组MAP和HR水平呈先升高后降低趋势（P<0.05），SpO2无显著变化（P>0.05）。在T1和T2时间点，观察组MAP和HR水平低于对照组，差异有统计学意义（P<0.05）。观察组检查中依托咪酯丙泊酚混合液和瑞芬太尼的用量均显著少于对照组（P<0.05）。与对照组相比，观察组检查中呛咳、苏醒期咳嗽情况更好，气道发痒发生率更低，差异有统计学意义（P<0.05）。观察组高血压和心律失常发生率显著低于对照组（11.25% vs 26.25%， χ2=5.932，P=0.015；10.00% vs 31.25%， χ2=11.063，P=0.001）。两组均未发生低氧血症和支气管痉挛。结论 丁卡因明视下气管内表面麻醉联合喉罩全麻可有效抑制支气管镜检查的心血管应激反应和气道反应，降低苏醒期不良反应发生率，具有临床推广应用价值。 |
| 关键词: 丁卡因 表面麻醉 全麻 支气管镜 应激反应 不良反应 |
| DOI：10.3969/j.issn.1674-3806.2025.09.11 |
| 分类号:R 614 |
| 基金项目:兵器工业卫生研究所科技开发费项目（编号：所科字〔2024〕129号-7） |
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| Observation on clinical effects of endotracheal surface anesthesia with tetracaine under bronchoscopic direct vision combined with general anesthesia using a laryngeal mask in bronchoscopy |
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ZHOU Ying1, SHU Tiankun1, NIE Huiyong2, WANG Shuang1, QUAN Pei1, HUANG Jing1
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1.Painless and Comfortable Medical Center, NORINCO General Hospital, Xi′an 710065, China; 2.Department of Pain Management, the First Affiliated Hospital of Xi′an Jiaotong University, Xi′an 710061, China
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| Abstract: |
| ［Abstract］ Objective To observe the clinical effects of endotracheal surface anesthesia with tetracaine under bronchoscopic direct vision combined with general anesthesia using a laryngeal mask in bronchoscopy. Methods A total of 160 patients who underwent elective bronchoscopy in NORINCO General Hospital from June 2024 to December 2024 were recruited and randomly divided into observation group(undergoing endotracheal surface anesthesia with tetracaine under bronchoscopic direct vision combined with general anesthesia using a laryngeal mask) and control group(undergoing endotracheal surface anesthesia with lidocaine under bronchoscopic direct vision combined with general anesthesia using a laryngeal mask) by using random number table method, with 80 patients in each group. The levels of heart rate(HR), mean arterial pressure(MAP) and pulse oxygen saturation(SpO2) were compared between the two groups before anesthesia(T0), 1 minute after the start of the examination(T1), 5 minutes after the start of the examination(T2) and 2 minutes after the removal of the laryngeal mask(T3). The choking cough scores during examination, cough scores during anaesthetic awakening period, incidence of itching in the airway, and the dosages of etomidate and propofol mixed liquids and remifentanil were compared between the two groups. The occurrence of adverse reactions in the patients during anaesthetic awakening period was recorded. Results At the time points from T0 to T3, there were no significant changes in the levels of SpO2, MAP and HR in the observation group(P>0.05), and the levels of MAP and HR in the control group showed a trend of first increasing and then decreasing(P<0.05), while the level of SpO2 showed no significant changes(P>0.05). At the time points of T1 and T2, the levels of MAP and HR in the observation group were lower than those in the control group, with statistically significant differences(P<0.05). The dosages of etomidate and propofol mixed liquids and remifentanil during the examination in the observation group were significantly less than those in the control group(P<0.05). Compared with the control group, the observation group showed better choking cough condition during examination and better coughing condition during anaesthetic awakening period, and had a lower incidence of itching in the airway, with statistically significant differences between the two groups(P<0.05). The incidence rates of hypertension and arrhythmia in the observation group were significantly lower than those in the control group(11.25% vs 26.25%, χ2=5.932, P=0.015; 10.00% vs 31.25%, χ2=11.063, P=0.001). No hypoxemia or bronchospasm occurred in either group. Conclusion Endotracheal surface anesthesia with tetracaine under bronchoscopic direct vision combined with general anesthesia using a laryngeal mask can effectively inhibit cardiovascular stress responses and airway responses in bronchoscopy, reduce the incidence of adverse reactions during anaesthetic awakening period, and has clinical promotion and application value. |
| Key words: Tetracaine Surface anesthesia General anesthesia Bronchoscope Stress response Adverse reactions |
