中国典型病例大全

目的 探讨静脉麻醉联合气管表面麻醉在喉罩通气下支气管镜检查治疗中的应用效果。方法 选取2022年1月—2023年6月在泰州市第四人民医院进行支气管镜检查治疗的60例患者作为研究对象，随机分为观察组和对照组，每组30例。观察组采用静脉麻醉联合气管内表面麻醉，对照组仅采用静脉麻醉。比较两组患者麻醉前(T₀)、麻醉后(T₁)、纤支镜进入声门后3 min(T₂)、灌洗刷检活检等操作时(T₃)、患者苏醒后(T₄)的心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)和血氧饱和度(blood oxygen saturation,SpO₂)变化，以及术中不良反应发生情况。结果 观察组患者在纤支镜进入声门后3 min、灌洗刷检活检等操作时、患者苏醒后的HR和MAP均低于对照组，差异有统计学意义(P<0.05)。两组患者SpO₂比较，差异无统计学意义(P>0.05)。观察组患者术中呛咳体动、术后严重咳嗽发生率明显低于对照组，差异有统计学意义(P<0.05)。结论 静脉麻醉联合气管表面麻醉在喉罩通气下支气管镜检查治疗中的应用具有血流动力学更加稳定，术中呛咳体动少，术后咳嗽轻等优点，是一种值得推广的安全、有效的麻醉方法。

Objective To explore the application effect of intravenous anesthesia combined with tracheal surface anesthesia during bronchoscopy examination and treatment under laryngeal mask ventilation. Methods Sixty patients undergoing bronchoscopy examination and treatment at Taizhou Fourth People's Hospital from January 2022 to June 2023 were randomLy divided into observation group and control group, with 30 cases in each group.The observation group was treated with intravenous anesthesia combined with tracheal surface anesthesia, while the control group was treated with intravenous anesthesia alone. The changes in heart rate(HR), mean arterial pressure(MAP), and blood oxygen saturation(SpO₂)before anesthesia(T₀), after anesthesia(T₁), 3 minutes after the bronchoscope entered the glottis(T₂), during procedures such as lavage, brush biopsy, etc(T₃), and after patient recovery(T₄)were compared between the two groups, as well as the incidence of intraoperative adverse reactions. Results The HR and MAP of the observation group patients 3 minutes after the bronchoscope entered the glottis, during procedures such as lavage, brush biopsy, etc, and after patient recovery were lower than those of the control group, with statistically significant differences(P<0.05). There was no statistically significant difference in SpO₂ between the two groups of patients(P>0.05). The incidence of intraoperative coμghing and body movement, and postoperative severe coμgh in the observation group was significantly lower than that in the control group, with statistically significant differences(P<0.05). Conclusion Intravenous anesthesia combined with tracheal surface anesthesia during bronchoscopy examination and treatment under laryngeal mask ventilation has the advantages of more stable hemodynamics, less incidence of intraoperative coμghing and body movement,and less postoperative severe coμgh. It is a safe and effective anesthesia method worth promoting.