婴幼儿纤维支气管镜诊疗中镇静技术的研究进展

doi:10.12372/jcp.2025.24e0301

摘要/Abstract

摘要：

纤维支气管镜在儿科的应用已有数十年，作为一种气道侵入性操作，纤维支气管镜对于患儿气管和肺部疾病的诊断和治疗具有重要意义。由于患儿在检查过程中配合程度低、气道相对狭窄及缺氧耐受能力差等因素影响，儿科纤维支气管镜检查技术的应用受到一定限制。因此，更加安全及舒适的患儿纤维支气管镜诊疗是必需的，纤维支气管镜诊疗镇静/麻醉可以提高诊疗患儿的舒适度和安全性。本文综述了近年来患儿纤维支气管镜镇静的研究进展，为临床提供参考。

关键词: 纤支镜, 镇静, 舒适化诊疗, 儿童

Abstract:

The use of fiberoptic bronchoscopy (FB) in pediatrics has been established over several decades, as an invasive airway procedure, FB is crucial for diagnosing and treating tracheal and pulmonary diseases in children. However, its application in pediatric patients is constrained by factors such as low patient cooperation, relatively narrow airways, and poor tolerance to hypoxia. Consequently, ensuring a safer and more comfortable FB examination and treatment for pediatric patients is imperative. Sedation and anesthesia during FB can significantly enhance the comfort and safety of the diagnostic and therapeutic procedures for pediatric patients. This review discusses recent advances in sedation techniques for pediatric patients undergoing FB and offers guidance for clinical practice.

Key words: fiberopic bronchoscopy, sedation, comfortable diagnosis and treatment, child

钟瑾虹, 王灿, 陈芳. 婴幼儿纤维支气管镜诊疗中镇静技术的研究进展[J]. 临床儿科杂志, 2025, 43(1): 50-55.

ZHONG Jinhong, WANG Can, CHEN Fang. Progress in the research of infantile fiberoptic bronchoscopy sedation[J]. Journal of Clinical Pediatrics, 2025, 43(1): 50-55.

参考文献 41

[1]	谢正德, 邓继岿, 任丽丽, 等. 儿童呼吸道感染病原体核酸检测专家共识[J]. 中华实用儿科临床杂志, 2022, 37(5): 321-332.
	Xie ZD, Deng JG, Ren LL, et al. Expert consensus on nucleic acid amplification test of respiratory pathogens in children[J]. Zhonghua Shiyong Erke Linchuang Zazhi, 2022, 37(5): 321-332.
[2]	Schramm D, Yu Y, Wiemers A, et al. Pediatric flexible and rigid bronchoscopy in European centers-availability and current practice[J]. Pediatr Pulmonol, 2017, 52(11): 1502-1508.
[3]	Ferraro VA, Baraldi E, Stabinger D, et al. Pediatric flexible bronchoscopy: a single-center report[J]. Pediatr Pulmonol, 2021, 56(8): 2634-2641.
[4]	国家卫生健康委员会人才交流服务中心儿科呼吸内镜诊疗技术专家组, 中国医师协会儿科医师分会内镜专业委员会, 中国医师协会内镜医师分会儿科呼吸内镜专业委员会, 等. 中国儿科可弯曲支气管镜术指南(2018年版)[J]. 中华实用儿科临床杂志, 2018, 33(13): 983-989.
	Technical Expert Group on Pediatric Respiratory Endoscopy Diagnosis and Treatment of Personnel Exchange Service Center of the National Health Commission, Endoscopy Professional Committee of the Pediatrician Branch of the Chinese Medical Doctor Association, Pediatric Respiratory Endoscopy Professional Committee of the Endoscopist Branch of the Chinese Medical Doctor Association, et al. Guidelines for pediatric flexible bronchoscopy in Chinese (2018 edition)[J]. Zhonghua Shiyong Erke Linchuang Zazhi, 2018, 33(13): 983-989.
[5]	Sachdev A, Chhawchharia R. Flexible fiberoptic bronchoscopy in pediatric practice[J]. Indian Pediatr, 2019, 56(7): 587-593. pmid: 31333214
[6]	黄赛虎, 孟祥营, 张建平, 等. 重症肺炎患儿肺泡灌洗液病原学分析及临床特点[J]. 中华实用儿科临床杂志, 2021, 36(4): 262-266.
	Huang SH, Meng XY, Zhang JP, et al. Etiological analysis and clinical characteristics of alveolar lavage fluid in children with severe pneumonia[J]. Zhonghua Shiyong Erke Linchuang Zazhi, 2021, 36(4): 262-266.
[7]	Gami A, Rinaldi K, Degefe YT, et al. Bronchoalveolar lavage in a pediatric population[J]. Am J Clin Pathol, 2022, 157(5): 678-684.
[8]	李忠强, 吴雪郡. 可弯曲支气管镜技术在儿科的临床应用进展[J]. 中华生物医学工程杂志, 2023, 29(1): 111-116.
	Li ZQ, Wu XJ. Progress in the clinical application of flexible bronchoscopy in pediatrics[J]. Zhonghua Shengwu Yixue Gongcheng Zazhi, 2023, 29(1): 111-116.
[9]	Islamitabar S, Gholizadeh M, Rakhshani MH, et al. Comparison of nebulized lidocaine and intratracheally injected (spray-as-you-go) lidocaine in pain and cough reduction during bronchoscopy[J]. Tanaffos, 2022, 21(3): 348-353.
[10]	武娜, 贾苗, 李立, 等. 利多卡因雾化吸入联合异丙酚在小儿纤维支气管镜检查中的作用[J]. 国际呼吸杂志, 2022, 42(11): 846-850.
	Wu N, Jia M, Li L, et al. Role of lidocaine nebulized inhalation combined with propofol in pediatric fibrobronchoscopy[J]. Guoji Huxi Zazhi, 2022, 42(11): 846-850.
[11]	邓小明, 王月兰, 冯艺, 等. (支)气管镜诊疗镇静/麻醉专家共识(2020版)[J]. 国际麻醉学与复苏杂志, 2021, 42(8): 785-794.
	Deng XM, Wang YL, Feng Y, et al. Expert consensus on sedation/anesthesia in tracheoscopy (2020 edition)[J]. Guoji Mazuixue yu Fusu Zazhi, 2021, 42(8): 785-794.
[12]	张亚东, 辛楠, 田海涛. 支气管肺泡灌洗治疗的麻醉管理进展[J]. 临床麻醉学杂志, 2022, 38(9): 984-987.
	Zhang Y, Xin N, Tian HT. Advances in anesthesia management for bronchoalveolar lavage therapy[J]. Linchuang Mazuixue Zazhi, 2022, 38 (9): 984-987.
[13]	中华医学会麻醉学分会诊疗性操作的镇静与麻醉方案指导意见工作组. 诊疗性操作的镇静与麻醉方案指导意见(一)[J]. 中华麻醉学杂志, 2023, 43(6): 641-647.
	Working Group on the Guidance of Sedation and Anesthesia Protocols for Diagnostic and Therapeutic Operations, Chinese Society of Anesthesiology. Guiding Opinions on Sedation and Anesthesia Protocols for Therapeutic Procedures (I)[J]. Zhonghua Mazuixue Zazhi, 2023, 43(6): 641-647.
[14]	Galway U, Zura A, Khanna S, et al. Anesthetic considerations for bronchoscopic procedures: a narrative review based on the Cleveland Clinic experience[J]. J Thorac Dis, 2019, 11(7): 3156-3170. doi: 10.21037/jtd.2019.07.29 pmid: 31463144
[15]	袁媛, 裴迎华, 张杰. 无痛支气管镜研究进展[J]. 国际呼吸杂志, 2017, 37(2): 157-160.
	Yuan Y, Pei YH, Zhang J. Research progress of painless bronchoscopy[J]. Guoji Huxi Zazhi, 2017, 37(2): 157-160.
[16]	Madan K, Biswal SK, Mittal S, et al. 1% Versus 2% Lignocaine for Airway Anesthesia in Flexible Bronchoscopy Without Lignocaine Nebulization (LIFE): A Randomized Controlled Trial. J Bronchology Interv Pulmonol, 2018, 25(2): 103-110. doi: 10.1097/LBR.0000000000000458 pmid: 29346249
[17]	中华医学会麻醉学分会诊疗性操作的镇静与麻醉方案指导意见工作组. 诊疗性操作的镇静与麻醉方案指导意见(三)[J]. 中华麻醉学杂志, 2023, 43(6): 658-664.
	Working Group on the Guidance of Sedation and Anesthesia Protocols for Diagnostic and Therapeutic Operations, Chinese Society of Anesthesiology. Guiding Opinions on Sedation and Anesthesia Protocols for Therapeutic Procedures (III)[J]. Zhonghua Mazuixue Zazhi, 2023, 43(6): 658-664.
[18]	Mallory MD, Travers C, Cravero JP, et al. Pediatric sedation/anesthesia for MRI: results from the pediatric sedation research consortium[J]. J Magn Reson Imaging, 2023, 57(4): 1106-1113.
[19]	孙茫, 刘阳, 于晴, 等. 瑞芬太尼或舒芬太尼复合丙泊酚在患儿纤维支气管镜检查中的应用[J]. 临床麻醉学杂志, 2016, 32(10): 949-952.
	Sun M, L Y, Y Q, et al. Application of remifentanil or sufentanil combined with propofol in flexible bronchoscopy in children[J]. Linchuang Mazuixue Zazhi2016, 32 (10): 949-952.
[20]	Zhong Y, Jiang M, Wang Y, et al. Evaluating efficacy and safety of sub-anesthetic dose esketamine as an adjuvant to propofol/remifentanil analgosedation and spontaneous respiration for children flexible fibreoptic bronchoscopy: a prospective, double-blinded, randomized, and placebo-controlled clinical trial[J]. Front Pharmacol, 2023, 14: 1184663.
[21]	Chaudhary S, Chaudhary S, Kumar M, et al. Fentanyl versus nalbuphine for intubating conditions during awake fiberoptic bronchoscopy: a randomized double-blind comparative study[J]. J Anaesthesiol Clin Pharmacol, 2021, 37(3): 378-382. doi: 10.4103/joacp.JOACP_359_19 pmid: 34759547
[22]	Wang L, Wu Q, Wang M, et al. The safety and efficacy of alfentanil combined with midazolam in fiberoptic bronchoscopy sedation: a randomized, double-blind, controlled trial[J]. Front Pharmacol, 2022, 13: 1036840.
[23]	Pastis NJ, Yarmus LB, Schippers F, et al. Safety and efficacy of remimazolam compared with placebo and midazolam for moderate sedation during bronchoscopy[J]. Chest, 2019, 155(1): 137-146.
[24]	季莹莹, 姜静, 侯慧艳, 等. 艾司氯胺酮联合右美托咪定用于小儿纤支镜检查安全性研究[J]. 儿科药学杂志, 2023, 29(3): 32-35.
	Ji YY, Jiang J, Hou HY, et al. Safety of esketamine combined with dexmedetomidine in pediatric fibroscopy[J]. Erke Yaoxue Zazhi, 2023, 29 (3): 32-35.
[25]	冯斌, 刘巍, 叶茂. 右美托咪定复合静脉全身麻醉在小儿纤支镜检查治疗中的应用[J]. 重庆医科大学学报, 2019, 44(6): 778-782.
	Feng B, Liu W, Ye M. Application of dexmedetomidine combined with venous general anesthesia in the treatment of pediatric bronchoscopy[J]. Chongqing Yike Daxue Xuebao, 2019, 44 (6): 778-782.
[26]	姚忠岩, 娄宁, 王玉, 等. 艾司氯胺酮复合丙泊酚用于患儿纤维支气管镜检查术的效果[J]. 中华麻醉学杂志, 2022, 42(11): 1385-1386.
	Yao ZY, Lou N, Wang Y, et al., Effect of esketamine combined with propofol in children undergoing fibrobronchoscopy[J]. Zhonghua Mazuixue Zazhi, 2022, 42(11): 1385-1386.
[27]	Choi EJ, Kim CH, Yoon JY, et al. Ketamine-propofol (ketofol) in procedural sedation: a narrative review[J]. J Dent Anesth Pain Med, 2023, 23(3): 123-133.
[28]	Foo TY, Mohd Noor N, Yazid MB, et al. Ketamine-propofol (Ketofol) for procedural sedation and analgesia in children: a systematic review and meta-analysis[J]. BMC Emerg Med, 2020, 20(1): 81. doi: 10.1186/s12873-020-00373-4 pmid: 33032544
[29]	朱超秀, 郑燕茹, 赵志虎. 艾司氯胺酮联合咪达唑仑在小儿增强CT检查中的镇静效果观察[J]. 中外医学研究, 2022, 20(26): 18-21.
	Zhu CX, Zheng YR, Zhao ZH. Observation on the sedative effect of esketamine combined with midazolam in pediatric contrast-enhanced CT examination[J]. Zhongwai Yixue Yanjiu, 2022, 20 (26): 18-21.
[30]	van de Bunt JA, Veldhoen ES, Nievelstein RAJ, et al. Effects of esketamine sedation compared to morphine analgesia on hydrostatic reduction of intussusception: a case-cohort comparison study[J]. Paediatr Anaesth, 2017, 27(11): 1091-1097. doi: 10.1111/pan.13226 pmid: 28940868
[31]	Huang X, Ai P, Wei C, et al. Comparison of the effects of esketamine/propofol and sufentanil/propofol on the Incidence of intraoperative hypoxemia during bronchoscopy: protocol for a randomized, prospective, parallel-group trial[J]. J Clin Med, 2022, 11(15): 4587.
[32]	Nie J, Chen W, Jia Y, et al. Comparison of remifentanil and esketamine in combination with propofol for patient sedation during fiberoptic bronchoscopy[J]. BMC Pulm Med, 2023, 23(1): 254. doi: 10.1186/s12890-023-02517-1 pmid: 37430293
[33]	杨珮宁, 叶元梅, 刘馨, 等. 不同麻醉方式与药物在支气管镜检查中的应用[J]. 兰州大学学报(医学版), 2022, 48(9): 71-76.
	Yang PN, Ye YM, Liu X, et al. Application of different anesthesia methods and drugs in bronchoscopy[J]. Lanzhou Daxue Xuebao (Yixueban), 2022, 48 (9): 71-76.
[34]	中华医学会儿科学分会急救学组, 中华医学会急诊医学分会儿科学组, 中国医师协会儿童重症医师分会. 中国儿童重症监护病房镇痛和镇静治疗专家共识(2018版)[J]. 中华儿科杂志, 2019, 57(5): 324-330.
	Emergency Medicine Group of Pediatric Branch of Chinese Medical Association, Pediatric Group of Emergency Medicine Branch of Chinese Medical Association, Pediatric Intensive Care Physician Branch of Chinese Medical Doctor Association. Expert consensus on analgesia and sedation in pediatric intensive care units in China (2018 edition)[J]. Zhonghua Erke Zazhi, 2019, 57(5): 324-330.
[35]	Riker RR, Picard JT, Fraser GL. Prospective evaluation of the sedation-agitation scale for adult critically ill patients[J]. Crit Care Med, 1999, 27(7): 1325-1329. doi: 10.1097/00003246-199907000-00022 pmid: 10446827
[36]	何冠凤, 何珊, 左泽兰. 重症监护室儿童镇静评估的研究进展[J]. 中国小儿急救医学, 2022, 29(1): 60-64.
	He GF, He S, Zuo ZL. Research progress on sedation assessment in children in intensive care units[J]. Zhonghua Xiao’er Jijiu Zazhi, 2022, 29(1): 60-64.
[37]	Cravero JP, Askins N, Sriswasdi P, et al. Validation of the pediatric sedation state scale[J]. Pediatrics, 2017, 139(5): e20162897.
[38]	张婉莹, 戴燕红, 金花, 等. 儿童镇静程度评估工具的研究进展[J]. 中华护理杂志, 2021, 56(11): 1644-1648. doi: 10.3761/j.issn.0254-1769.2021.11.007
	Zhang WY, Dai YH, Jin H, et al. Research progress on assessment tools for children's sedation[J]. Zhonghua Huli Zazhi, 2021, 56 (11): 1644-1648.
[39]	Rasheed AM, Amirah MF, Abdallah M, et al. Ramsay sedation scale and richmond agitation sedation scale: a cross-sectional study[J]. Dimens Crit Care Nurs, 2019, 38(2): 90-95. doi: 10.1097/DCC.0000000000000346 pmid: 30702478
[40]	Kerson AG, DeMaria R, Mauer E, et al. Validity of the richmond agitation-sedation scale (RASS) in critically ill children[J]. J Intensive Care, 2016, 4: 65. pmid: 27800163
[41]	Kihlstrom MJ, Edge AP, Cherry KM, et al. Multi-modal educational curriculum to improve richmond agitation-sedation scale inter-rater reliability in pediatric patients[J]. Pediatr Qual Saf, 2018, 3(5): e096.