注药型气管导管对腭咽成形术后留置导管期应激反应的影响  

Endotrcheal tube with injecting medicine can restrain stress reaction of patients after uvulopalatopharyngoplasty

作　　者：胡振华[1] 张俊莉[1] 童明军[1] 郑改芳[1] 刘胜群[1] 

机构地区：[1]河南省人民医院郑州大学人民医院麻醉科,450003

出　　处：《临床麻醉学杂志》2016年第10期980-983,共4页Journal of Clinical Anesthesiology

基　　金：河南省医学科技攻关项目(201303140)

摘　　要：目的评价注药型气管导管用于腭咽成形术后留置导管期对应激反应的影响。方法选择择期行悬雍垂腭咽成形术患者60例,均为男性,年龄18~60岁,ASAⅠ或Ⅱ级,随机分为A、B、C三组,每组20例。三组均静脉持续输注舒芬太尼5μg/h,A组每隔2小时经注药型气管导管注入2%利多卡因2ml,B组持续泵注右美托咪定0.4μg·kg^(-1)·h^(-1),C组不做处理。如出现高血压及心动过速,给予额外药物处理。记录入ICU即刻(T_0)、2h(T_1)、6h(T_2)、12h(T3)、拔管前即刻(T4)的HR、MAP、动脉血肾上腺素(E)及去甲肾上腺素(NE)水平,并记录入室至停药期间三组需药物调整HR、MAP的例数及呛咳反应发生情况。结果 T_1~T_4时A、B组HR明显慢于C组,T_2~T_4时B组HR明显慢于A组(P<0.05);T1~T4时A、B组MAP明显低于C组(P<0.05),且T2时A组MAP高于B组。T_1~T_4时A、B组动脉血E水平明显低于C组,且T1时A组动脉血E水平明显高于B组(P<0.05);T_1~T_4时A、B组动脉血NE水平明显低于C组,且T_1~T_3时A组动脉血E水平明显高于B组(P<0.05)。A组带管时间及ICU停留时间明显短于B组(P<0.05);A组药物干预例数明显少于C组,但多于B组,A、B组医患满意度均明显高于C组(P<0.05)。A组呛咳发生率(55%)明显低于C组(80%),呛咳程度明显轻于C组(P<0.05)。结论注药型气管导管间断注入局麻药可明显降低腭咽成形术后患者带管期间应激反应,稳定循环,并缩短患者拔管及ICU停留时间。Objective To evaluate the effect of stress reaction of＂endotrcheal tube with injecting medicine＂of patients after uvulopalatopharyngoplasty（UPPP）.Methods Sixty patients of severe OSAHS scheduled for UPPP were randomly allocated into three groups（n=20）.All patients were sedated with sufentanil 5μg/h.The patients of group A were injected 2ml of lidocaine（2%）per two hour in the ICU after surgery;the patients of group B were sedated with dexmedetomidine 0.4μg·kg^-1·h^-1.Group C were not treated.Hypertension or tachycardia,if occurred,were treated with extra medication.The level of stress hormone,HR and MAP were recorded upon entering ICU（T0）,2h（T1）,6h（T2）,12h（T3）and extubation（T4）.Results The HR of group A,B were slower than that of group C during T1-T4;the HR of group B was slower than that of group A during T2-T4（P〈0.05）.The MAP of group A,B were lower than that of group C during T1-T4;and the HR of group B was lower than group A at T2（P〈0.05）.The level of E and NE of group A,B were lower than that of group C during T1-T4;the level of NE of group B was lower than group A during T1-T3.The bucking of group A was obviously less than that of group C（P〈0.05）.The duration in ICU and the duration with endotrcheal tube of group A were shorter than that of group B（P〈0.05）.Patients and ICU doctors were more satisfied with group A compared with group C.The incidence of cough reflex in group A（55%）was lower than that in group C（80%）significantly.Conclusion Compared with group C,endotrcheal tube with injecting medicine can reduce the stress response and stable hemodynamics for the patients of severe OSAHS with mechanical ventilation after UPPP in ICU,and it can shorten the duration of the patients stay in ICU compare with group B.

关 键 词：注药型气管导管 腭咽成形术 应激反应 

分 类 号：R614.24[医药卫生—麻醉学]