刘颖,谢美云,于素卿.运用Ramsay镇静分级评价不同麻醉方法对支气管镜检查患者影响[J].转化医学杂志,2018,7(4):228-230
运用Ramsay镇静分级评价不同麻醉方法对支气管镜检查患者影响
Evaluation of different anesthesia methods for bronchoscopy using Ramsay sedation grade
  
DOI:
中文关键词:  Ramsay镇静分级  支气管镜  麻醉  评价
英文关键词:Ramsay  Bronchoscopy  Anesthesia  Evaluation
基金项目:包头市医药卫生科技发展基金(wsjj2016077)
作者单位
刘颖 包头医学院第三附属医院呼吸内科 
谢美云 包头医学院第三附属医院呼吸内科 
于素卿 包头医学院第三附属医院呼吸内科 
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中文摘要:
      目的 研究支气管镜检查过程中不同麻醉方法对患者的影响。方法 收集2015年1月1日—2016年1月1日于包头医学院第三附属医院行支气管镜检查的90名患者,随机分为A、B、C 3组,30例/组,A组给予利多卡因氧气加压口鼻面罩雾化,鼻腔喷药、气管内滴药进行表面麻醉;其余2组在A组的基础上分别给予咪达唑仑联合芬太尼静脉注射麻醉(B组)和右旋美托咪啶联合芬太尼静脉注射麻醉(C组),于检查前(T0)、气管镜进入声门前(T1)、进入声门后瞬间(T2)3个时间点观察受检者的呼吸频率、血压(收缩压)、心率、血氧饱和度变化,记录咳嗽、喘憋等不良反应,询问患者的遗忘情况及对下次检查是否可接受,并以Ramsay镇静分级评价B、C组患者的镇静程度。结果 T0点3组患者各项生命指征差异无统计学意义(P>0.05),各组间具有可比性;T1点A组与B、C组患者心率和血氧饱和度比较差异具有统计学意义(P<0.05);T2点A组与B、C组患者比较各项观察指标差异均有统计学意义(P<0.05),B、C组仅呼吸频率比较差异均有统计学意义(P<0.05);A组患者的咳嗽、憋气等不良反应出现频率高(20/30),其余2组分别为B组(5/30)、C组(3/30);A组患者对操作的不良记忆多,仅33.3%的患者表示勉强可接受再次气管镜检查,明显低于B组(90%)、C组(94%);运用Ramsay镇静分级评价B、C组患者的镇静程度,差异无统计学意义(P>0.05)。结论 在利多卡因表面麻醉的基础上联合静脉麻醉可以使支气管镜检查获得满意麻醉效果,舒适性、安全性更高。
英文摘要:
      Objective To investigate the effect of different anesthesia methods in bronchoscopy examination. Methods A total of 90 patients from January 1, 2015 to January 1, 2016 who received bronchoscopy operation in the Third Affiliated Hospital of Baotou Medical College were selected, and they were divided into groups A, B, C randomly, 30 cases in each group. Group A received lidocaine surface anaesthesia, group B received lidocaine surface anaesthesia combined with midazolam and fentanyl intravenous injection, group C received lidocaine surface anaesthesia combined with dexmedetomidine and fentanyl intravenous injection. Respiratory rate (RR), blood pre-ssure (BP), heart rate (HR), pulse oxygen saturation (SpO2) were monitored and recorded at T0 (before operation), T1 (before the bronchoscope enters the glottis), and T2 (just after the bronchoscope enters the glottis) time point. Adverse reactions were recorded, patients were asked if willing to accept another bronchoscopy examination, the sedation grade of patients in group B and C was evaluated by Ramsay sedation score. Results There were no significant differences in RR, BP, HR, and SpO2 among the 3 groups at T0 (P>0.05). Compared with group B and group C, HR and SpO2 in group A were statistically significant difference at T1. Compared with group B and group C, the differences of all the observations in group A were statistically significant at T2 (P<0.05). The difference of RR was statistically significant only between group B and group C at T2 (P<0.05). The patients in group A has a bad memory for the operation and lower willingness to check again and more adverse reactions compared with group B and group C. The degree of sedation of patients in group B and C was evaluated by Ramsay sedation grade, but the difference was not statistically significant (P>0.05). Conclusion On the basis of lidocaine surface anesthesia, combined intravenous anesthesia can make excellent anesthesia effects and more comfortable and safe.
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