中度镇静下支气管镜检查时雾化吸入局部麻醉药与常规给药应用的比较：随机对照试验
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Nebulization versus standard application for topical anaesthesia during flexible bronchoscopy under moderate sedation ： a randomized controlled trial
背景与目的
支气管内给予利多卡因常用于对诊断性支气管镜检查患者进行止咳。目前，已有研究报道，在深镇静下实施纤维支气管镜检查时雾化吸入利多卡因比常规局部注射具有显著的优越性，但未对中度镇静时进行研究。因此，本研究旨在比较中度镇静下雾化吸入利多卡因与常规注射利多卡因进行支气管镜检查时患者的耐受性和安全性。
方 法
将需要行诊断性支气管镜检查的患者随机分为注射器组或喷雾器组，两组患者分别通过注射器或雾化器局部给予利多卡因。主要观察指标为利多卡因和镇静药物的消耗量，以及病人的耐受性和安全性。
结 果
本研究共纳入60例行诊断性支气管镜检查患者(每组30例)。经喷雾器给药的患者支气管内利多卡因需要量较经注射器局部给药低(164.7±20.8mg vs 250.4±42.38mg；p<0.0001)。然而，两组患者镇静药物用量无显著性差异（P>0.05)。 此外，喷雾器组患者平均氧饱和度较注射器组高(96.19±2.45%vs.94.21±3.02%;p=0.0072)且并发症发生率较注射器组低(0.3±0.79vs.1.17±1.62%;p=0.0121)。
结 论
中度镇静下经雾化器给予支气管内利多卡因行支气管镜检查的患者在检查过程中耐受性较好，利多卡因用量少，并发症发生率低且氧合性好。
原始文献摘要
Müller T, Cornelissen C, Dreher M,Nebulization versus standard application for topical anaesthe-sia during flexible bronchoscopy under moderate sedation - a randomized controlled trial.[J] .Respir. Res., 2018, 19: 227.
Background: Endobronchial administration of lidocaine is commonly used for cough suppression during diagnostic bronchoscopy. Recently, nebulization of lidocaine during bronchoscopies under deep sedationwith fiberoptic intubation using a distinct spray catheter has been shown to have several advantages over conventional lidocaine administration via syringe. However, there are no data about this approach in bronchoscopies performed under moderate sedation.Therefore, this study compared the tolerability and safety of nebulized lidocaine with conventional lidocaine administration via syringe in patients undergoing bronchoscopy with moderate sedation.
Methods: Patients requiring diagnostic bronchoscopy were randomly assigned to receive topical lidocaine either via syringe or via nebulizer. Endpoints were consumption of lidocaine and sedative drugs, as well as patient tolerance and safety.
Results: Sixty patients were included in the study (n = 30 in each group). Patients required lower doses of endobronchial lidocaine when given via nebulizer versus syringe (164.7 ± 20.8 mg vs. 250.4 ±42.38 mg; p < 0.0001) whereas no differences in the dosage of sedative drugs were observed between the two groups (all p > 0.05).Patients in the nebulizer group had higher mean oxygen saturation(96.19 ± 2.45% vs. 94.21 ± 3.02%; p = 0.0072) and a lowercomplication rate (0.3 ± 0.79 vs. 1.17 ± 1.62 per procedure; p =0.0121) compared with those in the syringe group.
Conclusions: Endobronchial lidocaine administration via nebulizer was well-tolerated during bronchoscopies under moderate sedation and was associated with reduced lidocaine consumption, a lower complication rate and better oxygenation compared with lidocaine administration via syringe.
麻醉学文献进展分享
贵州医科大学高鸿教授课题组
翻译：何幼芹 编辑：何幼芹 审校：王贵龙