利多卡因不同给药方式在气管镜检查中麻醉效果对比观察
发布时间：2018-11-10 19:52
【摘要】：目的：对比电子支气管镜检查中临床常用的利多卡因含漱法、雾化吸入法、镜下滴注法的麻醉效果。 方法：本研究选取山东大学附属省立医院呼吸内镜室2013年8月至2013年10月首次行电子支气管镜检查的成人患者为研究对象,按照随机余数法分为3组,除外COPD、哮喘患者及近期有激素、支气管扩张药应用的患者,分别给予2%利多卡因(5ml:100mg)含漱法(NEB)、雾化吸入法(SPR)、镜下滴注法(BI)。检查后患者与气管镜操作人员分别应用视觉模拟评分法(VAS)和严重程度量表,主观评估气管镜检查各阶段局麻效果,并对操作过程录音,第三方参与分析声音波形,客观记录咳嗽、憋喘次数用以客观评估局麻效果。后进行亚组分析,对各治疗组根据性别、年龄、吸烟指数、体重指数分组,观察相同的利多卡因给药方式,以上因素对局麻效果的影响。运用SPSS16.0统计学软件,计量资料计算平均值,3组间均数比较采用方差分析；行*列表资料采用X2检验,等级资料组间差异性采用秩和检验(u检验、K-W检验),相关性检验采用皮尔逊相关系数,p0.05有统计学意义。 结果：(1)主观评估：患者的视觉模拟评分(VAS)、严重程度量表评分显示患者更倾向于应用雾化吸入法(NEB),应用NEB法在气管镜穿越咽喉、支气管树探查阶段耐受性更好。操作者的评估也提示NEB法引起不适感较轻。患者与操作者VAS量表明显相关。 (2)客观评估：雾化吸入法(NEB)患者咳嗽数明显少,出现支气管痉挛呼吸暂停次数NEB组较其他组少。操作过程中需经气管镜吸引通道追加利多卡因量NEB组明显少。 客观及主观的研究显示NEB法在电子支气管镜检查前可起到良好的局部麻醉效果,且未观察到明显不良反应。NEB(雾化吸入法)是患者与操作者首选的麻醉方式。 (3)亚组分析显示,行电子支气管镜检查术前给予利多卡因局部麻醉效果与性别、体重指数(BMI)无关；老年患者麻醉效果较青中年患者好,可适当减少局麻药物用量；吸烟指数超过400的患者麻醉效果欠佳。 结论：(1)电子支气管镜检查前给予2%利多卡因雾化吸入局麻是患者与操作者首选的麻醉方式。 (2)术前局麻效果与患者性别、体重指数无关；老年患者(年龄60岁)局麻效果较好；吸烟指数较高(400年支)患者麻醉效果较差。
[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).
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614
本文编号：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).
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614
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