全身麻醉下超声支气管镜引导针吸活检术的临床应用价值*

摘要： ：目的 探讨全身麻醉（静脉麻醉联合喉罩）下行超声支气管镜引导经支气管透壁针吸活检术 （EBUS-TBNA）的应用价值。方法 纳入2015 年6 月-2016 年10 月在该院呼吸内镜中心进行的103 例 EBUS-TBNA 的患者，随机分为局麻组和全麻组，全麻组以静脉麻醉联合喉罩进行麻醉，局麻组以常规丁 卡因局部麻醉，回顾性分析两组患者每例平均穿刺针数、诊断率、操作时间、并发症及舒适度方面的差异。 结果 全麻组平均每例穿刺针数5.6 针，局麻组3.1 针；全麻组诊断率94.12%，局麻组诊断率78.85%，两组诊 断率差异有统计学意义（χ2=5.11，P =0.024）；全麻组平均操作时间（14.61±1.52）min，局麻组平均操作时 间（32.52±4.14）min，两组比较差异有统计学意义（t =29.01，P =0.000）；全麻组术中出血人数及术中呛咳 人数均低于局麻组（χ2=4.31、103.00，P =0.038、0.000）。结论 全麻下进行EBUS-TBNA 诊断率高，操作 时间短，无痛、舒适度高且操作风险降低，值得临床推广。
Abstract: Objective To explore the application of transbronchial needle aspiration biopsy (EBUS-TBNA) combined with ultrasound bronchoscopy under the general anesthesia (intravenous anesthesia combined with laryngeal mask). Methods 103 patients with EBUS-TBNA from June 2015 to October 2016 were randomly divided into local anesthesia group and general anesthesia group. The anesthesia group was anesthetized with intravenous anesthesia combined with laryngeal mask, local anesthesia group with conventional tetracaine local anesthesia. The differences in the average number of puncture needles, the diagnosis rate, the operation time, the complications and the comfort of each group were analyzed retrospectively. Results The average number of puncture needle in each group was 5.6 times, and the local anesthesia group was 3.1 times. The diagnosis rate of general anesthesia group was 94.12% and local anesthesia group was 78.85%. There was significant difference between the two groups (χ2 = 5.11, P = 0.024). The average operation time in the general anesthesia group was (14.61 ± 1.52), the local anesthesia group was (32.52 ± 4.14), they had significant difference (t = 29.01, P = 0.000). The number of patients in bleeding and cough of the general anesthesia group were lower than those in the local anesthesia group (χ2 = 4.31, 103.00, P = 0.038, 0.000, respectively). Conclusions EBUS-TBNA under general anesthesia has high diagnostic rate, short operating time, painlessness, high comfort and reduce operational risk, worthy of promoting clinical application.