吕静　刁明　强文智

[摘要] 目的 探讨清醒镇静伴局部麻醉的支气管镜检查在肺癌患者围术期的应用效果，以筛选出更适合肺癌手术患者支气管镜检查的实施方法。 方法 回顾性分析2015年3月～2017年12月在德阳市人民医院行手术治疗且围术期行支气镜检查的326例肺癌患者的临床资料，根据麻醉方式将其分为局部麻醉组（A组，154例）和清醒镇静伴局部麻醉组（B组，172例）。通过术前评估、术中监测、术后调查和随访，观察患者的满意度，评估操作的安全性及对患者术后康复的影响。 结果 两组患者术中监测血氧饱和度变化、呼吸困难、胸痛方面差异无统计学意义（P > 0.05）；两组患者在检查操作时间、心率变化、通过声门的偿试次数、再次检查意愿反馈、不良记忆等方面差异有统计学意义（P < 0.01）。 结论 清醒镇静联合局部麻醉的方法能明显减轻肺癌手术患者对支气管检查的畏惧感，提高患者的满意度及耐受程度，能明显降低并发症发生率，具有很大的推广应用价值。

[关键词] 局部麻醉；清醒镇静；支气管镜检查；肺癌；围术期

[中图分类号] R768.1 [文献标识码] A [文章编号] 1673-7210（2018）04（b）-0004-05

The application of conscious sedation combined with local anesthesia bronchoscopy on lung cancer patients during the perioperative period

LV Jing DIAO Mingqiang WEN Zhi LIN Yan ZHAO Changming XUE Yang HONG Lan

Department of Cardiothoracic Surgery， People′s Hospital of Deyang City， Sichuan Province， Deyang 618000， China

[Abstract] Objective To investigate the effect of conscious sedation with local anesthesia bronchoscopy on lung cancer patients during the perioperative period and to find a better method for bronchoscopy. Methods Form March 2015 to December 2017， 326 patients received bronchoscopy during the perioperative period of surgery. These patients were divided into two groups according to the type of anesthesia： the local anesthesia group （Group A， 154 cases）， and the conscious sedation with local anesthesia group（Group B， 172 cases）. Preoperative evaluation， intraoperative monitoring， postoperative survey， and follow-up were conducted to assess the patients′ satisfaction， the safety of the operation， and the effect on postoperative rehabilitation of the surgery. Results No statistically significant difference of two groups was found in blood oxygen saturation， dyspnea， chest pain etc （P > 0.05）， while there was statistically significant differences in the examining time， heart rate changes， the number of attempt times before the bronchoscope to pass through the glottic， patients′ willingness for re-examination， and the bad memory etc of two groups （P < 0.01）. Conclusion Conscious sedation combined with local anesthesia method can reduce the patients′ fear for bronchoscopy in lung cancer surgery， improve the patients′ satisfaction and tolerance， and significantly reduce the incidence of complications. Therefore it has great application value.

[Key words] Conscious sedation； Local anesthesia； Bronchoscopy； Lung cancer； Perioperative period

肺癌是目前在世界范圍内发病率及死亡率均较高的恶性肿瘤[1]，支气管镜检查是呼吸系统疾病重要的诊治手段[2]，临床工作中无论是进行术前检查诊断还是围术期手术方式的制订，支气管镜检查都不可或缺，其重要性无可替代。传统的支气管镜检查时多采用局部黏膜表面浸润麻醉方法，其优点是简单、快捷、经济，但缺点也较为突出，主要是因为支气管镜直接刺激咽喉部及气道黏膜，患者在清醒状态下极易出现恶心、呛咳、气道痉挛、情绪紧张等进而影响呼吸、循环稳定或被迫中止检查[3]。而……