复方利多卡因乳膏与右美托咪定抑制全身麻醉拔管期呛咳反应效果比较  

Comparison of compound lidocaine cream and dexmedetomidine for suppression of bucking during endotracheal extubation of general anesthesia

作　　者：温传允 朱玫[1] 谢国柱[1] 孙灿林[1] Wen Chuanyun Zhu Mei Xie Guozhu Sun Canlin(Department of Anesthesiology,Taizhou Municipal People＇s Hospital, Jiangsu 225300, Chin)

机构地区：[1]泰州市人民医院麻醉科,江苏225300

出　　处：《现代医药卫生》2017年第18期2782-2784,共3页Journal of Modern Medicine & Health

摘　　要：目的比较复方利多卡因乳膏涂抹气管导管表面行气管黏膜表面麻醉与右美托咪定抑制全身麻醉拔管期呛咳反应的效果。方法选取该院2015年5月至2016年4月收治的甲状腺手术患者120例,按照随机数字表法分为复方利多卡因乳膏组(L组)、右美托咪定组(D组)和对照组(C组),每组40例。L组气管导管前1/2和套囊表面均匀涂抹复方利多卡因乳膏(约2 g);D组气管导管表面涂抹液状石蜡并从气管插管后至手术结束前30 min持续静脉滴注右美托咪定0.4μg/(kg·h);C组气管导管表面涂抹液状石蜡。观察三组患者拔管期呛咳反应的发生情况,记录术前(T_0)、拔管时(T_1)、拔管后1 min(T_2)和拔管后2 min(T_3)的有创平均动脉压(MAP)和心率(HR)变化,并跟踪随访患者术后不良反应的发生情况。结果 L组和D组患者拔管期中、重度呛咳反应发生率均低于C组,差异均有统计学意义(P<0.05);拔管期L组和D组有创MAP和HR均明显低于C组,差异均有统计学意义(P<0.05);与术前相比,C组拔管期有创MAP和HR均明显升高,差异均有统计学意义(P<0.05);而L组和D组拔管期有创MAP和HR均无明显变化,差异均无统计学意义(P>0.05)。D组术后不良反应发生率高于L组,差异有统计学意义(P<0.05)。结论复方利多卡因乳膏和右美托咪定均能有效抑制全身麻醉拔管期呛咳反应,有利于血流动力学稳定,复方利多卡因乳膏较右美托咪定更能明显降低术后不良反应发生率。Objective To compare the tracheal mucosal surface anesthesia coated with compound lidocaine cream and intraoperative dexmedetomidine infusion for suppression of bucking during endotracheal extubation of general anesthesia.Methods Totally 120 patients with thyroid surgery in the hospital from May 2015 to April 2016 were selected and divided into compound lidocaine cream group（group L）,dexedetomidine group（group D） and control group（group C） according to random number table,40 cases in each group. The former 1/2 and cuff surface of tracheal catheter in the group L were coated evenly with compound lidocaine cream（about 2 g）;the surface of tracheal catheter in the group D,who received dexmedetomidine infusion at a rate of 0.4 μg/（kg·h） from after induction of anaesthesia until 30 min before the end of operation,was coated with liquid paraffin;the surface of tracheal catheter in the group C was coated with liquid paraffin only. The incidences of bucking and adverse reac-tions in the three groups were recorded. The changes of invasive mean arterial pressure（MAP） and heart rate（HR） were recorded before induction（T_0）,during extubation（T_1）,at 1 min（T_2） and 2 min（T_3） after extubation. Results The incidence of medium and severe bucking during extubation in group L and group D was obviously lower than that in the group C with statistically significant difference（P〈0.05）. Compared with the group C,invasive MAP and HR were significantly decreased during extubation in the group L and the group D with statistically significant difference（P〈0.05）. Compared with before operation,the invasive MAP and HR in the group C both increased obvious ly during extubation with statistically significant difference（P〈0.05）,but the difference of invasive MAP and HR during extubation in the group L and group D had no statistical significance（P〈0.05）. The incidence rate of adverse reactions in the group D after op eration was higher than that in the group L with statisticall

关 键 词：利多卡因 软膏 右美托咪定 麻醉 全身 咳嗽 血流动力学 

分 类 号：R459.5[医药卫生—治疗学]