【摘要】目的 研究适合于无痛纤维支气管镜检查(fibreoptic bronchoscopy, FB)麻醉的气道管理手段。方法 选择无痛FB患者60例，用信封法随机分为3组（每组20例），I组鼻导管吸氧；Ⅱ组患者应用内镜面罩；Ⅲ组患者插入双管喉罩Supreme（Laryngeal Mask Supreme，塞舌尔），经面罩、喉罩行FB。记录镜检条件与入室后、FB前、纤支镜插入后2 min、活检或冲洗时、活检后2 min和出室前患者的脉搏血氧饱和度（SpO2）、收缩压（SBP）、舒张压（DBP）、心率（HR），记录手术时间、麻醉时间、SpO2下降需辅助、控制通气、退出纤支镜例（次）数和麻醉满意度。结果Ⅰ组有18例，Ⅱ组有16例，Ⅲ组有3例患者SpO2降至90％以下（与Ⅰ组比较P＜0.01），3组分别有35、5、1人次SpO2降低至85％以下，需行控制通气（与Ⅰ组比较，P＜0.01）。术者满意率Ⅱ组（50％）、Ⅲ组（95％）高于I组（15％）（Ⅱ组： P＜0.05，Ⅲ组：P＜0.01）。结论 老年患者无痛FB应用内镜专用面罩或置入喉罩进行气道管理，可减少术中缺氧发生率，提高麻醉满意率，且不增加麻醉时间。喉罩尤其可靠。
【Abstract】Objective To investigate the appropriate airway manage method in elderly painless fibreoptic bronchoscopy patients． Methods 60 patients scheduled for painless fibreoptic bronchoscopy were randomly divided into 3 groups，patients in group I oxygen with nasal cannula，groupⅡwith endoscopy facial mask and group Ⅲ double-tube laryngeal mask．Record bronchoscopy examination condition and systolic blood pressure (SBP)、diastolic blood pressure (DBP)、heart rate (HR)、pulse oximeter saturation (SpO2) just before bronchoscopy，2 min after insertion，biopsy or flushing，2min after biopsy and leaving the operating room． The operation time，anesthesia time，SpO2 decline to 90%，85% were also recorded．Results Patients in Group Ⅱ，Ⅲ experienced fewer intraoperative hypoxemia （Ⅰ 18；Ⅱ 16；Ⅲ 3）and operation suspension （Ⅰ 35；Ⅱ 5；Ⅲ 1）(P＜0.01) ，the satisfaction for anesthesia was also higher than group I（15%） （groupⅡ 50%：P＜0.05；group Ⅲ 95%：P＜0.01）．Conclusion Application of endoscopy facial mask，especially laryngeal mask in elderly painless fibreoptic bronchoscopy patients can reduce the incidence of intraoperative hypoxia，increase anesthesia satisfaction without increasing the anesthesia time．
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