表面麻醉复合全身麻醉对成人低温等离子扁桃体消融术术中血流动力学的影响  

The effect of surface anesthesia combined with general anesthesia on hemodynamics of adult cryogenic plasma tonsillectomy

作　　者：后瑞淼 郭瑞娟[2] 仇焕容[2] 洪方晓[2] 丁冠男[2] HO U Rui - miao;GUO Rui -juan;QIU Huan - rong(Department of Anesthesiology, Unicare ENT Hospital, Beijing 100122, China;Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.)

机构地区：[1]北京优联耳鼻喉医院麻醉科,北京100122 [2]首都医科大学附属北京友谊医院麻醉科,北京100050

出　　处：《临床和实验医学杂志》2018年第11期1144-1147,共4页Journal of Clinical and Experimental Medicine

基　　金：国家自然科学基金(编号:81400909)

摘　　要：目的观察利多卡因或丁卡因表面麻醉复合全身麻醉对成人扁桃体手术术中血流动力学的影响。方法选择2017年北京友谊医院收治的60例18~60岁、ASAⅠ~Ⅱ级的行低温等离子扁桃体消融术的患者进行前瞻性研究。随机数字表法将患者分为三组,对照组(C组)、2%利多卡因组(L组)和1%丁卡因组(T组),每组各20例。C组常规全身麻醉诱导;L组在咽喉部给予2%利多卡因5 ml之后再行全身麻醉;T组在咽喉部给予1%丁卡因5 ml之后再行全身麻醉。分别在患者入室后(T0),诱导后插管前(T1),插管后1 min(T2),插管后5 min(T3),手术开始1 min(T4),手术开始10 min(T5),手术结束即刻(T6),自主呼吸恢复(T7),拔管后1 min(T8),麻醉恢复室(T9)时间点记录患者的平均动脉压(MAP)和心率(HR)。比较三组患者的MAP、HR、呼吸恢复时间、睁眼时间和拔管时间。结果与T0时间点相比,C组患者在T2、T4、T7、T8时间点,MAP和HR明显升高(P<0.05),而L组和T组在各个时间点均无明显变化(P>0.05)。与C组相比,L组和T组的呼吸恢复时间、睁眼时间和拔管时间均明显降低(P<0.05)。结论利多卡因或丁卡因进行表面麻醉复合全身麻醉有助于维持成人低温等离子扁桃体消融术患者术中血流动力学的稳定,同时加快术后苏醒。Objective To observe the effect of surface anesthesia combined with general anesthesia on hemodynamics in adult patients with cryogenic plasma tonsillectomy. Methods 60 patients（ aging 18 - 60 years,ASA Ⅰ - Ⅱ） with cryogenic plasma tonsillectomy were chosen to participate in this prospective study at Beijing Friendship Hospital in 2017. These patients were divided into control group（ group C）,2% lidocaine group（ group L） and 1% tetracaine group（ group T） by random number table. Conventional general anesthesia was used in group C. 2%lidocaine（ 5 ml） for surface anesthesia was given to the throat before general anesthesia in group L. 1% tetracaine（ 5 ml） were given in the throat before general anesthesia in group T. The mean arterial pressure（ MAP） and heart rate（ HR） of patients in these three groups were recorded and compared at the following time points： before induction（ T0）,before intubation（ T1）,1 min after intubation（ T2）,5 min after intubation（ T3）,1 min after surgery（ T4）,10 min after surgery（ T5）,the end of surgery（ T6）,spontaneous breathing recovery（ T7）,1 min after extubation （ T8） and post anesthesia care unit（ PACU）（ T9）. Meanwhile,the time of spontaneous breathing recovery,opening eyes and extubation were also recorded. Results In comparison with T0 time point,MAP and HR were significantly increased at T2,T4,T7 and T8 time points in group C（ P〈0. 05）. While MAP and HR unchanged at any time point in group L and group T（ P〉0. 05）. In comparison with group C,the periods of spontaneous breathing recovery,open eyes and extubation were significantly decreased in group L and group T（ P〈0. 05）. Conclusion By using lidocaine or tetracaine for surface anesthesia combined with general anesthesia can effectively maintain the hemodynamic stability in adult cryogenic plasma tonsillectomy and promote the recovery of these patients.

关 键 词：低温等离子扁桃体消融术 表面麻醉 全身麻醉 血流动力学 

分 类 号：R614[医药卫生—麻醉学]