利多卡因不同給藥方式在氣管鏡檢查中麻醉效果對比觀察
發(fā)布時間：2018-11-10 19:52
【摘要】：目的：對比電子支氣管鏡檢查中臨床常用的利多卡因含漱法、霧化吸入法、鏡下滴注法的麻醉效果。 方法：本研究選取山東大學附屬省立醫(yī)院呼吸內鏡室2013年8月至2013年10月首次行電子支氣管鏡檢查的成人患者為研究對象,按照隨機余數法分為3組,除外COPD、哮喘患者及近期有激素、支氣管擴張藥應用的患者,分別給予2%利多卡因(5ml:100mg)含漱法(NEB)、霧化吸入法(SPR)、鏡下滴注法(BI)。檢查后患者與氣管鏡操作人員分別應用視覺模擬評分法(VAS)和嚴重程度量表,主觀評估氣管鏡檢查各階段局麻效果,并對操作過程錄音,第三方參與分析聲音波形,客觀記錄咳嗽、憋喘次數用以客觀評估局麻效果。后進行亞組分析,對各治療組根據性別、年齡、吸煙指數、體重指數分組,觀察相同的利多卡因給藥方式,以上因素對局麻效果的影響。運用SPSS16.0統(tǒng)計學軟件,計量資料計算平均值,3組間均數比較采用方差分析；行*列表資料采用X2檢驗,等級資料組間差異性采用秩和檢驗(u檢驗、K-W檢驗),相關性檢驗采用皮爾遜相關系數,p0.05有統(tǒng)計學意義。 結果：(1)主觀評估：患者的視覺模擬評分(VAS)、嚴重程度量表評分顯示患者更傾向于應用霧化吸入法(NEB),應用NEB法在氣管鏡穿越咽喉、支氣管樹探查階段耐受性更好。操作者的評估也提示NEB法引起不適感較輕。患者與操作者VAS量表明顯相關。 (2)客觀評估：霧化吸入法(NEB)患者咳嗽數明顯少,出現支氣管痙攣呼吸暫停次數NEB組較其他組少。操作過程中需經氣管鏡吸引通道追加利多卡因量NEB組明顯少。 客觀及主觀的研究顯示NEB法在電子支氣管鏡檢查前可起到良好的局部麻醉效果,且未觀察到明顯不良反應。NEB(霧化吸入法)是患者與操作者首選的麻醉方式。 (3)亞組分析顯示,行電子支氣管鏡檢查術前給予利多卡因局部麻醉效果與性別、體重指數(BMI)無關；老年患者麻醉效果較青中年患者好,可適當減少局麻藥物用量；吸煙指數超過400的患者麻醉效果欠佳。 結論：(1)電子支氣管鏡檢查前給予2%利多卡因霧化吸入局麻是患者與操作者首選的麻醉方式。 (2)術前局麻效果與患者性別、體重指數無關；老年患者(年齡60歲)局麻效果較好；吸煙指數較高(400年支)患者麻醉效果較差。
[Abstract]:Objective: to compare the anesthetic effect of lidocaine gargle, atomization inhalation and drip under electron bronchoscopy. Methods: adult patients who underwent electronic bronchoscopy from August 2013 to October 2013 in the Department of Respiratory Endoscopy, affiliated to Shandong University, were selected as the study subjects. They were divided into 3 groups according to the method of random remainder, excluding COPD,. Asthma patients and patients with recent hormone and bronchiectasis drugs were given 2% lidocaine (5ml:100mg) gargle (NEB), atomization inhalation method (SPR), instillation under the microscope (BI). After the examination, the patients and the operators of tracheoscopy were assessed by visual analogue scoring method (VAS) and severity scale respectively. The local anesthetic effect of each stage was evaluated subjectively, and the sound waveforms were recorded and analyzed by the third party. Objective records of cough and asthma were used to evaluate the effect of local anesthesia objectively. Then the subgroup analysis was carried out. According to sex, age, smoking index and body mass index, the treatment groups were divided into groups, and the same lidocaine administration methods were observed, and the effect of the above factors on the local anesthetic effect was observed. SPSS16.0 statistical software was used to calculate the mean value of the metrological data, and the analysis of variance was used to compare the mean among the three groups. Row * tabular data were tested by X2 test, rank sum test (u test, K-W test) and Pearson correlation coefficient were used in correlation test (p0.05). Results: (1) subjective evaluation: the visual analogue score (VAS),) score of the patients showed that the patients were more inclined to use the atomization inhalation method (NEB), method and NEB method to pass through the throat under tracheoscope. Bronchus tree exploration stage is more tolerant. The operator's assessment also suggested that the NEB method caused mild discomfort. There was a significant correlation between the patient and the operator VAS. (2) objective evaluation: the number of cough in (NEB) patients with atomization inhalation was significantly less than that in other groups, and the number of times of bronchiospasm apnea in NEB group was less than that in other groups. During the operation, the need for trachea tracheal suction channel to add lidocaine dose NEB group was significantly less. Objective and subjective studies showed that the NEB method had a good local anesthetic effect before the electronic bronchoscopy, and no obvious adverse reaction was observed by. NEB (atomization inhalation method) is the first choice of anesthesia for patients and operators. (3) Subgroup analysis showed that the effect of local anesthesia given to lidocaine before operation was not related to sex and body mass index (BMI), the anesthetic effect of elderly patients was better than that of young and middle-aged patients, and the dosage of local anesthetic drugs could be reduced appropriately. Patients with a smoking index above 400 had poor anesthetic effects. Conclusion: (1) Local anesthesia with 2% lidocaine atomization inhalation before electronic bronchoscopy is the first choice for patients and operators. (2) the preoperative effect of local anesthesia was not related to gender and body mass index of the patients, the effect of local anesthesia was better in elderly patients (age 60 years), and the effect of local anesthesia in patients with high smoking index (400 years old) was worse than that in patients with high smoking index (400 years).
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R614
本文編號：2323445
[Abstract]:Objective: to compare the anesthetic effect of lidocaine gargle, atomization inhalation and drip under electron bronchoscopy. Methods: adult patients who underwent electronic bronchoscopy from August 2013 to October 2013 in the Department of Respiratory Endoscopy, affiliated to Shandong University, were selected as the study subjects. They were divided into 3 groups according to the method of random remainder, excluding COPD,. Asthma patients and patients with recent hormone and bronchiectasis drugs were given 2% lidocaine (5ml:100mg) gargle (NEB), atomization inhalation method (SPR), instillation under the microscope (BI). After the examination, the patients and the operators of tracheoscopy were assessed by visual analogue scoring method (VAS) and severity scale respectively. The local anesthetic effect of each stage was evaluated subjectively, and the sound waveforms were recorded and analyzed by the third party. Objective records of cough and asthma were used to evaluate the effect of local anesthesia objectively. Then the subgroup analysis was carried out. According to sex, age, smoking index and body mass index, the treatment groups were divided into groups, and the same lidocaine administration methods were observed, and the effect of the above factors on the local anesthetic effect was observed. SPSS16.0 statistical software was used to calculate the mean value of the metrological data, and the analysis of variance was used to compare the mean among the three groups. Row * tabular data were tested by X2 test, rank sum test (u test, K-W test) and Pearson correlation coefficient were used in correlation test (p0.05). Results: (1) subjective evaluation: the visual analogue score (VAS),) score of the patients showed that the patients were more inclined to use the atomization inhalation method (NEB), method and NEB method to pass through the throat under tracheoscope. Bronchus tree exploration stage is more tolerant. The operator's assessment also suggested that the NEB method caused mild discomfort. There was a significant correlation between the patient and the operator VAS. (2) objective evaluation: the number of cough in (NEB) patients with atomization inhalation was significantly less than that in other groups, and the number of times of bronchiospasm apnea in NEB group was less than that in other groups. During the operation, the need for trachea tracheal suction channel to add lidocaine dose NEB group was significantly less. Objective and subjective studies showed that the NEB method had a good local anesthetic effect before the electronic bronchoscopy, and no obvious adverse reaction was observed by. NEB (atomization inhalation method) is the first choice of anesthesia for patients and operators. (3) Subgroup analysis showed that the effect of local anesthesia given to lidocaine before operation was not related to sex and body mass index (BMI), the anesthetic effect of elderly patients was better than that of young and middle-aged patients, and the dosage of local anesthetic drugs could be reduced appropriately. Patients with a smoking index above 400 had poor anesthetic effects. Conclusion: (1) Local anesthesia with 2% lidocaine atomization inhalation before electronic bronchoscopy is the first choice for patients and operators. (2) the preoperative effect of local anesthesia was not related to gender and body mass index of the patients, the effect of local anesthesia was better in elderly patients (age 60 years), and the effect of local anesthesia in patients with high smoking index (400 years old) was worse than that in patients with high smoking index (400 years).
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R614
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