無痛鎮靜麻醉對高血壓患者支氣管內超聲引導下經支氣管針吸活檢血壓的影響

晉發 楊健 朱穎等

[摘要] 目的 觀察無痛鎮靜麻醉對高血壓患者支氣管內超聲引導下經支氣管針吸活檢（EBUS-TBNA）血壓的影響。 方法 選取2016年1月～2017年12月南京醫科大學附屬江寧醫院呼吸內科收治的胸部強化CT示縱隔及肺門占位病變的高血壓患者70例，其中40例患者在無痛鎮靜麻醉下行EBUS-TBNA檢查（PR組，n = 40），30例在局部麻醉下行EBUS-TBNA檢查（L組，n = 30）。觀察采取兩種麻醉方式檢查時，兩組患者血壓、心率、血氧飽和度的變化，并對麻醉效果、檢查中患者的主觀感受和不良反應進行評價。 結果 L組患者在檢查中、檢查后的血壓與麻醉前的血壓比較均有所上升，差異有統計學意義（P < 0.05），PR組患者在檢查中、檢查后的血壓與麻醉前的血壓比較均有所下降，差異有統計學意義（P < 0.05）;PR組麻醉效果顯著優于L組，確診率明顯高于L組，取材不滿意率明顯低于L組，差異均有統計學意義（均P < 0.05）;與L組比較，PR組在檢查中更易出現心動過緩，兩組均未出現其他嚴重并發癥。 結論 與局部麻醉比較，無痛鎮靜麻醉能顯著降低患者術中或術后血壓，更加適用于高血壓患者EBUS-TBNA檢查。

[關鍵詞] 超聲引導下經支氣管針吸活檢;高血壓;利多卡因;丙泊酚;瑞芬太尼

[中圖分類號] R734? ? ? ? ? [文獻標識碼] A? ? ? ? ? [文章編號] 1673-7210（2019）02（a）-0108-04

[Abstract] Objective To observe the effect of painless sedation and anesthesia on blood pressure in patients with hypertension by endobronchial ultrasound-guided transbronchial needle aspiration biopsy （EBUS-TBNA）. Methods From January 2016 to December 2017， 70 cases of hypertension patients with mediastinal and hilar occupying lesions on chest enhanced CT admitted to the Department of Respiratory Medicine of Jiangning Hospital Affiliated to Nanjing Medical University were selected. EBUS-TBNA examination was performed in 40 patients under painless sedation and anesthesia （PR group， n = 40）， and EBUS-TBNA examination was performed in 30 patients under local anesthesia （L group， n = 30）. The changes of blood pressure， heart rate and blood oxygen saturation in the two groups were observed when the two anesthesia methods were used for examination， and the anesthetic effect， subjective feelings and adverse reactions of the patients in the examination were evaluated. Results Blood pressure of patients in the L group increased during and after examination compared with that before anesthesia， and the difference was statistically significant （P < 0.05）. The blood pressure of patients in the PR group decreased during and after the examination compared with that before anesthesia， and the difference was statistically significant （P < 0.05）. The anesthesia effect of PR group was significantly better than that of L group， the diagnosis rate was significantly higher than that of L group， and the satisfaction rate of sampling was significantly lower than that of L group， the difference was statistically significant （P < 0.05）. Bradycardia was more common in PR group than in L group， and no other serious complications were found in both groups. Conclusion Compared with local anesthesia， painless sedation anesthesia can significantly reduce patients′ intraoperative or postoperative blood pressure， which is more suitable for ebus-tbna examination in patients with hypertension.

[Key words] Endobronchial ultrasound-guided transbronchial needle aspiration; Hypertension; Lidocaine; Propofol; Remifentanil

臨床縱膈內淋巴結檢測主要通過超聲引導下經支氣管針吸活檢（endobronchial ultrasound-guided transbronchial needle aspiratio，EBUS-TBNA）進行組織細胞學檢查，并具有高準確性、高敏感性及創傷性低等優點[1]。需EBUS-TBNA檢查的患者多伴有并發癥，其中高血壓屬于最為常見并發癥之一。有研究[2]提示EBUS-TBNA由于檢查必須經氣道精細檢查，因而保持患者上呼吸道通暢與在氣道內的長時間操作具有矛盾性。

研究[3]提示EBUS-TBNA的麻醉方式對檢查的正常進行具有密切相關性。目前，臨床關于EBUS-TBNA的麻醉方式主要分為局部麻醉和無痛鎮靜麻醉，具體麻醉效果存在分歧。故而，本研究觀察無痛鎮靜麻醉方式用于高血壓患者支氣管內EBUS-TBNA時，對患者血壓的影響，現報道如下：

1 資料與方法

1.1 一般資料

選取2016年1月……