经气管导管行气管及咽部表麻在气管拔管中的应用  

Application of Transtracheal Intubation for Tracheal and Pharyngeal Surface Anesthesia in Tracheal Extubation

作　　者：刘厚东[1] 罗伟波[1] 莫灿强 罗丽清[1] LIU Houdong;LUO Weibo;MO Canqiang(Qiaotou Hospital,Dongguan 523523,China)

机构地区：[1]广东省东莞市桥头医院,广东东莞523523

出　　处：《中国医学创新》2018年第18期1-7,共7页Medical Innovation of China

基　　金：广东省东莞市医疗卫生单位科技计划类科研项目(201510515000346)

摘　　要：目的:比较2%利多卡因经气管导管逆行气管及咽部表麻与静脉注射两种给药方式对全身麻醉手术(除外气道和心脏手术)的患者苏醒期气管拔管前后发生咳嗽和血流动力学反应的差异。方法:选取本院接受气管插管全麻手术的患者90例,按照随机数字表法将其分为静脉注射利多卡因组(LI)组和气管及咽部利多卡因表麻组(LL组),各45例。LI组采用气管及咽部注入氯化钠注射液和静注利多卡因方法,LL组采用气管及咽部注入利多卡因和静注氯化钠注射液方法。比较两组麻醉诱导前(T诱导前),外科手术结束时(T_0),气管拔管前0 min(T_1),气管拔管后0 min(T_2)、5 min(T_3)、10 min(T_4)的心率(HR)、平均脉压(MAP);比较两组舒芬太尼用量、麻醉时间、气管拔管时间、睁眼时间、T_3时的呼吸频率及镇静评分、呛咳发生率及程度、不良反应。结果:T_1~T_4时,两组HR、MAP均较T0有不同程度的上升,比较差异均有统计学意义(P<0.05);T_2时,LL组MAP、HR均低于LI组,比较差异均有统计学意义(P<0.05);拔除气管导管前及拔除气管导管时,LI组呛咳反应发生率及程度均强于LL组,比较差异均有统计学意义(P<0.05);两组其他指标比较差异均无统计学意义(P>0.05)。结论:手术(除外气道和心脏手术)后,2%利多卡因经气管导管行气管、喉及咽部表麻较静脉注射更能有效抑制全身麻醉苏醒期的咳嗽和血流动力学反应。Objective：To compare the difference of cough and hemodynamic response between 2% Lidocaine on tracheal and pharyngeal surface anesthesia and intravenous injection through tracheal tube in patients undergoing general anesthesia（except cardiac and airway surgery）.Method：A total of 90 patients undergoing tracheal intubation general anesthesia in our hospital were selected.According to the random number table method,they were divided into Lidocaine intravenous group（LI group） and endotracheal and pharynx Lidocaine surface anesthesia group（LL group）,45 cases in each group.LI group was injected with Sodium Chloride Injection and intravenous Lidocaine by trachea and pharynx,and LL Group was injected with Lidocaine and intravenous injection of Sodium Chloride Injection by trachea and pharynx. The heart rate（HR）,mean pulse pressure（MAP） of before induction of anesthesia（Tpre）,at the end of the surgery（T0）,before tracheal extubation 0 min（T1）,after tracheal extubation 0 min（T2）,5 min（T3） and 10 min（T4） in two groups were compared,Sufentanil dosage,anesthesia time,tracheal extubation time,open eye time,respiratory frequency and sedation score at T3,cough incidence and degree,adverse reaction in two groups were compared.Result：At T1-T4,HR and MAP in two groups were increased to different degrees compared with T0,the differences were statistically significant（P〈0.05）.At T2, MAP and HR in LL group were lower than those of LI group,the differences were statistically significant（P〈0.05）.The incidence and degree of cough reaction in LI group were stronger than those of LL group before and after removal of endotracheal tube,the differences were statistically significant（P〈0.05）.The other indicators of two groups were compared,the differences were not statistically significant（P〈0.05）.Conclusion：After surgery（except cardiac and airway surgery）,compared with intravenous injection,2% Lidocaine on tracheal and pharyngeal surface anesthesia can effectively

关 键 词：全身麻醉 利多卡因 气管拔管 气管 咽 气压 重力 体位 表面麻醉 

分 类 号：R614[医药卫生—麻醉学]