Analysis Of The Influencing Factors Of Cough During Bronchoscopy And The Value Of FeNO And CRP In Predicting Cough Severity

Background and Objective:Bronchoscopy has become the main force in the diagnosis and treatment of respiratory diseases.At present,clinical bronchoscopy is often used in:Routine examinations,sputum aspiration,bronchoalveolar lavage,local injection,hemostasis,biopsy in various ways,such as Transbronchial lung biopsy(TBLB),transbronchial needle aspiration(TBNA),endobroncheal ultrasonographic-transbronchial needle aspiration(EBUS-TBNA),etc.In recent years,the technique of interventional therapy such as transbronchial treatment of airway stenosis,bronchial lung volume reduction surgery(BLVR),bronchial thermoplasty are also growing in popularity and development.Continuous mechanical stimulation of airway is given during bronchoscopy.It inevitably brings discomfort,anxiety,fear to the subject,which can cause severe cough,hypoxemia,tachycardia,high blood pressure and other serious complications such as laryngotracheal and bronchial spasm,hemorrhage,severe arrhythmia and so on.In the inspection process,good anesthesia effect can reduce the occurrence of adverse reactions.However,we found that even in the case of good anesthesia,the operation is still prone to cough.Moderate and severe cough is an important cause of complications such as tracheal spasm,hypoxemia and arrhythmia.The purpose of this study is to investigate the factors related to the degree of cough in patients during the inspection process.15 possible related factors are listed according to clinical experience(Age,gender,type of disease,history of allergy,history of smoking,history of alcohol consumption,CRP,FEND,external diameter,operating site,operator,type of operation,duration,remifentanil dosage,midazolam dosage)to evaluate the degree of cough during the operation.The relationship between above factors and coughis analyzed statistically,and CRP,FeNO are evaluated whether they can be used as a predictor of intraoperative cough,so as toprovide a basis for clinicians to evaluate the safety of the operation process.Methods:66 patients with bronchoscopy indications and without contraindications were selected from the First Affiliated Hospital of Kunming Medical University from November 2016 to January 2017.The data of patient were collected,including age,sex,disease,allergy history,smoking history,drinking history,etc.Preoperative CRP and FeNO level were detected.The mode of operation,site of operation and anesthesia method were developed according to the actual condition.The operating time,remifentanil and midazolam dosage were recorded and the degree of cough was assessed.According to the degree of cough during the operation,the patients were divided into three groups:no cough,mild cough,moderate cough and severe cough group.The Logistic regression analysis was performed on the above factors to analyze the influence of related factors on cough during operation.Results:66 patients all had cough during bronchoscopy.The incidence of mild cough was 47%,the incidence of moderate cough was 30%,and the incidence of severe cough was 7.6%.There was significant difference between the history of smoking,the external diameter of the trachea,the dosage of fentanyl,the dosage of midazolam and the cough.(P<0.05)No smoking history(B=-1.027,P=0.047,OR=0.358,95%confidence interval 0.124?0.929).That is,the possibility of a moderate cough in patients with a history of smoking was 1/0.358=2.793 times higher than those without a history of smoking.(OR=2.793)the external diameter of the bronchoscope(B=1.455,P=0.017,OR=4.274,95%confidence interval 1.302?14.085).That is,the possibility of moderate cough in patients with larger diameter bronchoscopy was 4.274 times higher than that of patients who were treated with a smaller bronchoscope(OR=4.274).The external diameter of the bronchoscopy was an independent factor for moderate cough.The correlation between remifentanil and midazolam and cough during operation is considered as a clinical consideration:,It seemed that the increase of cough in the patients was caused by the increased dosage of midazolam and remifentanil,but actually,When patients cough worse during bronchoscopy,the operater may increase the dosage of anaesthetic to decrease cough.The age,gender,type of disease,allergy history,smoking history,drinking history,the degree of cough in the operation were not correlated,and the difference was not statistically significant(P>0.05).Operation site,operator,duration,FeNO,CRP also were not correlated and the degree of cough in the operation were not correlated,but this result was not fit the actual situation,we need to enlarge the sample size to test again.Conclusions:(1)The history of smoking and the external diameter of bronchoscopy are the factors that cause moderate cough in the operation,and the external diameter of the bronchoscopy is an independent factor for moderate cough.Patients with a history of smoking are 2.793 times more likely to have moderate cough during surgery.The possibility of moderate cough in patients with larger diameter bronchoscopy is 4.274 times higher than that of patients who are treated with a smaller bronchoscope.(2)Requiring patients to quit smoking has a positive effect on the success and safety of bronchoscopy.Improving the accuracy of the operation technology and good anesthesia can reduce the cough caused by the increased external diameter of the bronchoscopy.(3)In this experiment,the degree of cough and gender,age,food,drug allergy history,drinking history were not statistically significant.(4)Operator,operation site,operation time,disease types,Preoperative detection of FeNO and CRP in predicting the degree of cough in the operation were not correlated,but this result was not fit the actual situation,we need to enlarge the sample size to test again?...