清醒镇静行支气管镜在AECOPD合并 呼吸衰竭患者中的临床观察

Clinical Observation of Conscious Sedation and Bronchoscopy in AECOPD Patients with Respiratory Failure

摘要: 目的：观察清醒镇静行支气管镜在慢性阻塞性肺病急性加重(AECOPD)合并呼吸衰竭患者中的临床效果。方法：选取2021年07月至2023年06月于柳州市中医医院行支气管镜的AECOPD合并I型及II型呼吸衰竭患者各90例，采用随机数字表法分局部麻醉组、清醒镇静组、深度镇静组，每组30例。局部麻醉组仅使用利多卡因；清醒镇静组在局部麻醉基础上加用咪达唑仑及芬太尼，使Ramsay评分在2~4分；深度镇静组在局部麻醉基础上加用咪达唑仑及芬太尼，使Ramsay评分在5~6分。监测麻醉前(T0)、进镜至声门时(T1)、留取肺泡灌洗液时(T2)、术后15分钟时(T3)的心率(HR)、平均动脉压(MAP)、外周氧饱和度(SPO₂)，记录T0、T3时间点患者血气分析的PH、PaO₂、PaCO₂。结果：清醒镇静与深度镇静相比，在各时间节点监测HR、MAP、SPO₂差异无统计学意义(P > 0.05)，清醒镇静与局部麻醉在T1、T2时间节点监测HR、MAP、SPO₂差异有统计学意义(P < 0.05)；T3时间节点中，清醒镇静PaO₂与局部麻醉差异有统计学意义(P < 0.05)，清醒镇静PaCO₂与深度镇静差异有统计学意义(P < 0.05)。结论：针对AECOPD合并呼吸衰竭患者，在清醒镇静下行支气管镜，可减轻患者痛苦，提高患者舒适度，减少全身性麻醉药物所带来的呼吸抑制，降低二氧化碳潴留，值得临床推广。

Abstract: Objective: Observing the clinical effect of conscious sedation bronchoscopy in patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) complicated with respiratory failure. Methods: From July 2021 to June 2023, 90 AECOPD patients with type I/II respiratory failure undergoing bronchoscopy at Liuzhou Traditional Chinese Medicine Hospital were randomly divided into local, conscious sedation, and general anesthesia groups (30 each). The local group received only lidocaine; the conscious sedation group received midazolam and fentanyl for a Ramsay score of 2~4; the general group received the same for a score of 5~6. HR, MAP, and SPO₂ were monitored at T0 (pre-anesthesia), T1 (glottis insertion), T2 (BALF collection), and T3 (15 min post-op). pH, PaO₂, and PCO₂ were recorded at T0 and T3. Results: No significant differences in HR, MAP, and SpO₂ were observed between conscious and deep sedation at any time point (P > 0.05), while significant differences were found between conscious sedation and local anesthesia at T1 and T2 (P < 0.05). At T3, PaO₂ differed significantly between conscious sedation and local anesthesia (P < 0.05), and PaCO₂ differed significantly between conscious and deep sedation (P < 0.05). Conclusion: For AECOPD patients with respiratory failure, bronchoscopy under conscious sedation reduces pain, improves comfort, minimizes respiratory depression from general anesthetics, and lowers CO₂ retention, warranting clinical use.