咪达唑仑静脉麻醉与利多卡因局部麻醉联合在纤维支气管镜检查和治疗中的疗效比较

目的:探讨咪达唑仑静脉麻醉联合利多卡因局部麻醉在纤维支气管镜(FOB)检查和治疗中的疗效。方法:将我院在2013年1月~2014年1月期间需行FOB检查的118例患者随机分为试验组和对照组,各59例,对照组采用利多卡因局部麻醉,试验组患者在局部麻醉基础上予以咪达唑仑0.05 mg/kg。记录麻醉前(T0)、FOB进入咽腔时(T1)、进入声门时(T2)、进入支气管时(T3)的平均动脉压(MAP)、心率(HR)、血氧饱和度(Sp O2),并在各个时间点进行镇静评分,记录检查过程中的不良反应、知晓程度及检查结束后患者的满意度。结果:两组Ramsay评分随时间的麻醉时间延长而逐渐升高,T2、T3时两组间比较差异均有统计学意义(P0.05);试验组T1、T2、T3时MAP、HR、Sp O2较T0时差异无统计学意义(P0.05),试验组T1、T2、T3时点MAP、HR均较对照组低(P0.05),Sp O2均较对照组高,差异有统计学意义(P0.05);试验组的呛咳、躁动、中止检查及操作知晓率均明显低于对照组,而满意率明显高于对照组,差异有统计学意义(P0.05)。结论:咪达唑仑静脉麻醉与利多卡因局部麻醉联合在FOB检查和治疗中可以减轻心血管反应,减少插管反应及操作时的知晓率,安全性较高,值得临床推广应用。

Application of MidazolamIntravenous Anesthesia Combined with Lidocaine Local Anaesthesia in Examination and Treatment of Fiberoptic Bronchoscopy

Objective:To explore the effect of midazolam intravenous anesthesia combined with lidocaine local anaesthesia in the examination and treatment of fiberoptic bronchoscopy (FOB).Methods:A total of 118 patients ,who would be detected by FOB in Second Central Hospital of Baoding from January 2013 to January 2015, were randomly into divided into test group (n=59) and control group (n=59). The control group received lidocaine local anaesthesia, while the test group was added midazolam0.05 mg/kg on the basis of control group. Then the mean artery pressure (MAP), hart rate (HR), SpO2 before anesthesia (T0), FOB into the pharynx cavity(T1), FOB into glottis(T2), FOB into the bronchus(T3) were recorded, giving Ramsay scores at each time point, and the side effects, awareness during the examination and satisfaction after examination were written down.Results:Ramsay scores of the two groups were rising along with the extending of anaesthesia time, and there was a statistical significance in the scores between the two groups at T2 and T3(P<0. 05). There was no statistical significance in the levels of MAP, HR and SpO2 between T1, T2, T3 and T0 in the test group (P>0.05). The levels of MAP and HR in the test group were lower than those in the control group at T1, T2, T3 (P<0.05), SpO2 was higher than that in the control group (P<0.05). The choking cough, restlessness, suspension check and operation awareness rate in the test group were lower than those in the control group, while the satisfaction rate was higher than that in the control group (P<0.05).Conclusion:Midazolam intravenous anesthesia combined with lidocaine local anaesthesia can ease the cardiovascular response, decrease the intubation response and awareness in the examination and treatment of FOB, with high satisfaction and safety,which is worthy of clinical application.