文章摘要
经鼻高流量氧疗支持下深肌松免插管麻醉在肺结核患者纤维支气管镜检查中的应用
Application of non-intubation deep paralysis with high-flow nasal oxygen in pulmonary tuberculosis patients undergoing fiberoptic bronchoscopy
  
DOI：10.12089/jca.2026.01.003
中文关键词: 经鼻高流量氧疗  深肌松免插管麻醉  纤维支气管镜  肺结核  低氧血症
英文关键词: High-flow nasal oxygenation  Non-intubation deep paralysis anesthesia  Fiberoptic bronchoscopy  Pulmonary tuberculosis  Hypoxemia
基金项目:南京市卫生科技发展专项资金项目计划（YKK21125）
作者单位E-mail
解东明 210029,南京医科大学第一临床医学院  
王佳 南京中医药大学附属南京医院麻醉科  
邓友明 南京中医药大学附属南京医院麻醉科  
殷国平 南京中医药大学附属南京医院麻醉科  
刘存明 210029,南京医科大学第一临床医学院 1335587409@qq.com 
摘要点击次数: 1472
全文下载次数: 384
中文摘要:
      
目的：探究经鼻高流量氧疗支持下深肌松免插管（H-NIDP）麻醉在肺结核患者纤维支气管镜检查中应用的有效性和安全性。
方法：选择择期行无痛纤维支气管镜检查的肺结核患者，年龄18～64岁，BMI 18.5～25.0 kg/m2，ASA Ⅰ或Ⅱ级。采用随机数字法将患者分为两组：H-NIDP组（H组）和传统静脉组（C组）。H组采用H-NIDP麻醉；C组采用传统静脉麻醉。两组均采用相同麻醉诱导及维持方案，其中H组术中使用高流量装置吸氧，且在患者意识消失后给予罗库溴铵0.6 mg/kg；C组术中使用鼻导管吸氧。主要指标为术中低氧血症（SpO2＜90%且持续30 s）发生率。次要指标包括术前、苏醒后PaCO2，术中呛咳评分，麻醉诱导前5 min、插入纤维支气管镜即刻、纤维支气管镜进至隆突时、纤维支气管镜退出时及麻醉苏醒后HR、MAP和SpO2，术中环泊酚及瑞芬太尼用量、操作时间、苏醒时间、手术室时间，患者和操作者满意度情况以及术中高血压、低血压、体动、心动过速、心动过缓以及术后咽痛、恶心、呕吐等不良反应的发生情况。
结果：共纳入患者60例，每组30例。与C组比较，H组低氧血症发生率、呛咳评分明显降低，操作时间、手术室时间明显缩短，术中高血压、体动、心动过速及术后咽痛发生率明显降低，苏醒后PaCO2、操作者满意度明显升高（P＜0.05）。两组术前PaCO2、术中环泊酚及瑞芬太尼用量、患者满意度、术中低血压、心动过缓、术后恶心呕吐等不良反应的发生率差异无统计学意义。
结论： 与传统静脉麻醉比较，H-NIDP麻醉用于肺结核患者无痛纤维支气管镜检查可显著降低检查过程中低氧血症的发生率，有效抑制患者呛咳反应，提高了操作者满意度，且不良反应更少。
英文摘要:
      
Objective: To investigate the efficacy and safety of non-intubation deep paralysis anesthesia with nasal high-flow oxygen therapy (H-NIDP) in tuberculosis patients undergoing fiberoptic bronchoscopy.
Methods: Pulmonary tuberculosis patients aged 18-64 years, BMI 18.5-25.0 kg/m2, ASA physical status Ⅰ-Ⅱ scheduled for painless fiberoptic bronchoscopy were randomly assigned to H-NIDP group (group H) or conventional intravenous anesthesia group (group C). Group H received H-NIDP anesthesia, with high-flow oxygen therapy and rocuronium 0.6 mg/kg administered after loss of consciousness. Group C received conventional intravenous anesthesia with nasal cannula oxygen. The primary outcome was the incidence of intraoperative hypoxemia (SpO2 < 90%). Secondary outcomes included the preoperative and post-anesthesia PaCO2 levels, the intraoperative choking cough score, and HR, MAP, and SpO2 before anesthesia induction for 5 minutes, immediately after the insertion of the fiberoptic bronchoscope, when the fiberoptic bronchoscope reached the carina, when it was withdrawn, and after anesthesia recovery, propofol and remifentanil consumption, procedure and recovery times, operator/patient satisfaction, and occurrence of adverse reactions such as intraoperative hypertension, hypotension, body movement, tachycardia, bradycardia, and postoperative sore throat, nausea, and vomiting.
Results: Sixty patients were included and allocated, 30 patients in each group. Compared to group C, group H had significantly lower incidences of hypoxemia and cough, shorter procedure and operating room times, reduced rates of hypertension, movement, tachycardia, and postoperative sore throat, and higher operator satisfaction (P < 0.05). No significant differences were observed in preoperative PaCO2, propofol/remifentanil use, patient satisfaction, hypotension, bradycardia, or postoperative nausea/vomiting.
Conclusion: H-NIDP anesthesia in tuberculosis patients undergoing fiberoptic bronchoscopy significantly reduces hypoxemia, suppresses cough, and improves operator satisfaction with fewer adverse events compared to conventional intravenous anesthesia.
查看全文   查看/发表评论  下载PDF阅读器
关闭