气管导管表面涂抹复方利多卡因乳膏预防经鼻蝶窦垂体瘤手术全麻苏醒期呛咳的有效性研究  

Topical anesthetic effects of compound lidocaine cream on the prevention of coughing during anesthetic emergence in transphenoidal surgery for pituitary adenomas

作　　者：曲歌[1] 桑诺尔[1] 薛杨[1] 张征[2] 黄宇光[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院麻醉科,100730 [2]中国医学科学院北京协和医学院北京协和医院手术室,100730

出　　处：《北京医学》2016年第5期458-460,共3页Beijing Medical Journal

摘　　要：目的评价复方利多卡因乳膏涂抹气管导管用于气管黏膜表面麻醉对提高经鼻蝶窦垂体瘤苏醒期拔除气管导管平稳性的有效性。方法本研究为前瞻随机对照研究,连续纳入北京协和医院60例经鼻蝶窦垂体瘤手术的患者,随机分为试验组(L组)和对照组(C组)。将L组气管导管前二分之一和套囊表面均匀涂布复方利多卡因乳膏,C组导管表面涂抹石蜡油。研究终点为苏醒期的呛咳事件。记录围术期血流动力学指标、患者在麻醉恢复室(PACU)的拔管时间,随访住院期间并发症。结果拔管期的自发呛咳率L组低于C组(7%vs.40%,P<0.01);诱发的呛咳率L组显著低于C组(20%vs.60%,P<0.01)。术毕至拔管时间L组小于C组[(18±6)min vs.(27±6)min,P<0.05]。需要追加芬太尼的患者比例L组低于C组(17%vs.70%,P<0.01)。L组的收缩压与心率乘积在拔管时和拔管后1 min均低于C组(P<0.05)。结论对于全麻经鼻蝶窦垂体瘤手术,气管导管表面涂抹复方利多卡因乳膏进行气管黏膜表面麻醉能有效减少苏醒期患者的呛咳事件、减少芬太尼补救用药量、缩短术毕至拔管时间并降低拔管时血流动力学波动。Objective To evaluate the effects of compound lidocaine cream（CLC） on prevention of cough during emergence in patients undergoing transphenoidal surgery for pituitary adenomas under general anesthesia. Methods This was a randomized, controlled, double- blinded trial, 60 patients scheduled for transphenoidal surgery for pituitary adenomas were continuously enrolled. Patients were randomized into two groups. Group L was intubated with endotracheal tube coated with CLC, and Group C（control group） were intubated with endotracheal tube coated with liquid paraffin. The end point of study was incidence of coughing during anesthetic emergence. Hemodynamic parameters were recorded. Fentanyl consumption and time duration from closing to extubation were noted. Patients were followed for major complications during their stay in hospital. Results Compared with Group C, there were decreased incidences of spontaneous cough（P〈0.01） and induced cough（P〈0.01） in Group L; the time duration from closing to extubation was reduced in Group L（P〈0.05）; and lower rates of additional fentanyl was needed in Group L（P〈0.01）. The values of SBP×HR were decreased in Group L at extubation and 1 min after extubation（P〈0.05）. Conclusion The topical anesthetic effects of CLC could reduce incidence of coughing during emergence in patients undergoing transphenoidal surgery for pituitary adenomas under general anesthesia. It shortens the time duration from surgery closing to extubation, decreased fentanyl consumption in PACU, and keeps hemodynamic profiles more stable at extubation.

关 键 词：复方利多卡因乳膏 表面麻醉 垂体瘤手术 全麻苏醒 呛咳 

分 类 号：R614[医药卫生—麻醉学] R736.4[医药卫生—外科学]