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投稿时间：2019-08-10 网络发布日期：2020-04-20
投稿时间：2019-08-10 网络发布日期：2020-04-20
中文摘要: 目的 探讨老年慢性阻塞性肺疾病(COPD)患者施行无痛支气管镜检查的安全性和有效性。
方法 采用回顾性队列研究方法,选取2015年11月至2018年9月在江苏省中医院呼吸科行纤维支气管镜、合并存在轻度COPD的老年患者共247例,其中施行无痛支气管镜检查者123例(无痛组),采用利多卡因局部雾化,并联合丙泊酚、地佐辛静脉镇静镇痛麻醉;施行普通支气管镜检查者124例(普通组),只采用利多卡因局部雾化麻醉。对两组患者循环和呼吸相关指标进行比较,对气道反应性和患者感受度进行评分(两种评分均以0分为最佳,4分为最差)。
结果 检查过程中循环指标:无痛组患者的血压(BP)、平均动脉压(MAP)和心率(HR)最高值、最低值均低于普通组(P<0.05,P<0.01);其变化值ΔBP［(12.1±6.7)mm Hg vs (44.8±17.7)mm Hg,P<0.01］、ΔMAP［(10.6±2.3)mm Hg vs (21.6±5.9)mm Hg,P<0.01］和ΔHR ［(8.7±4.7)次/min vs (33.5±13.5)次/min,P<0.01］均明显低于普通组,即BP、HR波动小于普通组。检查过程中呼吸指标:无痛组患者的呼吸频率(RR)最大值、最小值低于普通组,指脉氧饱和度(SpO2)最大值、最小值高于普通组(P均<0.01);其变化值ΔRR［(3.7±2.0)次/min vs (17.2±4.8) 次/min,P<0.01］和ΔSpO2［(1.6±1.6)% vs (9.0±2.7)%,P<0.01］均明显低于普通组,即RR、SpO2波动小于普通组。无痛组的气道反应评分分级分布(U=4.55,P<0.01)和患者感受主观评分分级分布(U=13.22,P<0.01)也优于普通组。两组均未发生严重不良反应。
结论 对老年轻度COPD患者施行无痛纤维支气管镜检查,患者的循环和呼吸更加平稳,氧合更加容易维持,并且有更加舒适的体验,安全性可靠。
Abstract:Objective To investigate the safety and effectiveness of painless bronchial examination in elderly patients with chronic obstructive pulmonary disease (COPD).
Methods A retrospective cohort study was conducted in 247 elderly patients with mild COPD who underwent fiberoptic bronchoscopy in the Respiratory Department of Jiangsu Province Hospital of Chinese Medicine from November 2015 to September 2018.
One hundred and twenty-three patients who underwent painless tracheoscopy were treated with local atomization of lidocaine combined with intravenous analgesia with propofol and dezocine（painless group）,and 124 patients who underwent general tracheoscopy were treated with local atomization anesthesia of lidocaine only(ordinary group).
The circulatory and respiratory-related indicators were compared between the two groups,and airway responsiveness and patient′s perception were scored (both scores were 0 for the best and 4 for the worst).
Results The highest and lowest values of blood pressure (BP),mean arterial pressure (MAP),and heart rate (HR) in patients in painless group were lower than those in ordinary group (P<0.05,P<0.01);and their changes in ΔBP［(12.1±6.7) mm Hg vs (44.8±17.7) mm Hg,P<0.01］,ΔMAP［(10.6±2.3) mm Hg vs (21.6±5.9) mm Hg,P<0.01］,and ΔHR［(8.7±4.7) times/min vs (33.5±13.5) times/min,P<0.01］were significantly lower than those in ordinary group,
that is,the fluctuations of BP and HR decreased in painless group compared with ordinary group.The maximum and minimum respiratory frequency (RR) of patients in painless group were lower than those in ordinary group,and the maximum and minimum values of pulse oxygen saturation (SpO2) were higher than those in ordinary group (all P<0.01);and their changes in ΔRR［(3.7±2.0) times/min vs (17.2±4.8) times/min,P<0.01］ and ΔSpO2［(1.6±1.6)% vs (9.0±2.7)%,P<0.01］ were significantly lower than those in the ordinary group,that is,
the fluctuations of RR and SpO2 decreased in painless group compared with ordinary group.
The grading distribution of airway response score(U=4.55,P<0.01) and the grading distribution of patients′ subjective perception score (U=13.22,P<0.01) in painless group were better than those in ordinary group.
No serious adverse reactions occurred in either group.
ConclusionPainless fiberoptic bronchoscopy is performed in elderly patients with mild COPD.Their circulation and breathing are more stable,oxygenation is easier to maintain,and there is a more comfortable experience and safety.
keywords: Chronic obstructive pulmonary disease Elderly Painless Bronchoscopy Circulatory function Respiratory function Airway reactivity Patient′s perception
文章编号： 中图分类号： 文献标志码：A
基金项目:国家自然科学基金资助项目(81774081)
引用文本：
陆晓旻,王晓,朱际平.老年慢性阻塞性肺疾病患者施行无痛支气管镜检查的安全性和有效性回顾性队列分析[J].中国临床研究,2020,33(4):456-460.
陆晓旻,王晓,朱际平.老年慢性阻塞性肺疾病患者施行无痛支气管镜检查的安全性和有效性回顾性队列分析[J].中国临床研究,2020,33(4):456-460.