目的 探究双向接头型伸缩管连接喉罩在无痛支气管镜检查治疗中的应用价值.方法 前瞻性选取2022年1月至2023年5月期间在西电集团医院行纤维支气管镜检查与治疗的80例患者作为研究对象.采用随机数表法将患者分为观察组和对照组各40例,观察组患者采用双向接头型伸缩管连接喉罩麻醉方式,对照组患者采用口腔气道表面喷洒丁卡因麻醉方式.比较两组患者在麻醉前(T0)、进镜前(T1)、支气管镜通过声门部(T2)、检查中(T3)和检查结束(T4)这5个时间点的血压(BP)、血氧饱和度(SpO2)、心率(HR)、血氧分压(PO2)等指标;比较两组患者的镜检时间和检查期间有无体动、中断操作、呛咳等情况以及术后咽喉部疼痛、不能发声、声嘶等不良反应;术后问卷调查患者对操作的满意度以及对内镜医师的麻醉满意度.结果 两组患者T1时BP较T0时明显下降,差异有统计学意义(P<0.05);观察组患者SpO2、HR、BP、MAP术中术后各时间点(T2、T3、T4)分别与其术前比较差异均无统计学意义(P>0.05);对照组患者的SpO2在T2明显低于T0、T1、T3、T4,且明显低于观察组,对照组患者的HR、BP、MAP在T2明显高于T0、T1、T3、T4,且各指标明显高于观察组,差异均有统计学意义(P<0.05);观察组患者的术中体动、术中呛咳、中断操作、术后咽喉部疼痛、声嘶、不能发声情况发生率分别为7.50%、7.50%、5.00%、5.00%、2.50%、2.50%,明显低于对照组的45.00%、57.50%、25.00%、25.00%、15.00%、17.50%,差异均有统计学意义(P<0.05);观察组患者的镜检时间为(9.53±2.31)min,明显短于对照组的(18.65±3.51)min,患者对操作和医师的满意度得分分别为(96.52±2.34)分、(95.48±2.37)分,明显高于对照组的(54.60±1.38)分、(60.64±1.42)分,差异均有统计学意义(P<0.05).结论 双向接头型伸缩管连接喉罩在无痛支气管镜检查治疗中能有效解决检查过程中的通气问题,有助于稳定血流动力学,减少呼吸抑制,减少患者痛苦记忆,提升患者对操作和医师的满意度.
Objective To explore the application value of bidirectional telescopic tube-connected laryngeal mask in painless bronchoscopy.Methods A total of 80 patients undergoing fiberbronchoscopy and treatment in Xidian Group Hospital from May 2022 to May 2023 were prospectively selected and divided into an observation group and a control group by random number table method,with 40 cases in each group.Patients in observation group were anesthe-tized by bidirectional telescopic tube-connected laryngeal mask,while patients in the control group were anesthetized by spraying tetracaine on the surface of oral airway.Blood pressure(BP),oxygen saturation(SpO2),heart rate(HR),oxygen partial pressure(PO2)were observed and recorded at 5 time points before anesthesia(T0),before endoscopy(T1),bron-choscopic passage through glottis(T2),during examination(T3),and at the end of examination(T4).The time of micro-scopic examination and the presence of body movement,operation interruption,coughing,postoperative throat pain,in-ability to sound and hoarseness were compared between the two groups.The postoperative questionnaire was used to in-vestigate the patients'satisfaction with the operation and anesthesia of endoscopists.Results BP at T1 was significant-ly lower than that at T0 in the two groups(P<0.05).In the observation group,there was no significant difference in SpO2,HR,BP,and MAP between T2,T3,T4 and T0(P>0.05);SpO2 in control group at T2 was significantly lower than that at T0,T1,T3 and T4,which was also significantly lower than that in the observation group;HR,BP,and MAP in the control group at T2 were significantly higher than that at T0,T1,T3,and T4,and the indexes were significantly higher than those in the observation group;the differences were statistically significant(P<0.05).In the observation group,the incidence of intraoperative body movement,intraoperative cough,operation interruption,postoperative throat pain,hoarseness,and inability to make sound were 7.50%,7.50%,5.00%,5.00%,2.50%,2.50%,which were significantly lower than 45.00%,57.50%,25.00%,25.00%,15.00%,17.50%in the control group(P<0.05).The microscopic examina-tion time of the observation group was(9.53±2.31)min,which was significantly shorter than(18.65±3.51)min of the control group;the satisfaction scores of the patients with the operation and doctors were(96.52±2.34)points and(95.48±2.37)points,which were significantly higher than(54.60±1.38)points and(60.64±1.42)points of the control group;the differences were statistically significant(P<0.05).Conclusion The bidirectional telescopic tube-connected laryngeal mask can effectively solve the ventilation problem during the examination in painless bronchoscopy,help to stabilize he-modynamics,reduce respiratory depression,reduce patients'painful memory,and improve patients'satisfaction with the operation and doctors.