利多卡因气管支气管表面麻醉在左侧双腔支气管插管中的应用  

Application Of Lidocaine Tracheobronchial Surface Anesthesia In Left Double-lumen Bronchial Intubation

作　　者：陈庆[1] CHEN Qing(Department of Anesthesiology,Nanjing Jiangning Hospital Affiliated to Nanjing Medical University,Nanjing 211100,China)

机构地区：[1]南京医科大学附属南京市江宁医院麻醉科,江苏南京211100

出　　处：《中国医药指南》2020年第15期22-23,26,共3页Guide of China Medicine

摘　　要：目的观察利多卡因气管支气管表面麻醉在左侧双腔支气管插管中应用的安全性和可行性。方法选择全身麻醉下行左侧双腔支气管插管的患者70例,采用随机数字表法分为利多卡因组和对照组。利多卡因组:麻醉诱导完成后,在纤维支气管镜下应用2%利多卡因对咽喉部、声门、气管及左主支气管进行表面麻醉,然后插入气管导管。对照组:麻醉诱导完成后直接插入气管导管。观察并记录2组患者麻醉前(T0)、气管插管前(T1)、左侧双腔支气管导管插管后(T2)、侧卧位时(T3)、单肺通气20 min时(T4)的收缩压(SBP)、舒张压(DBP)、和心率(HR)。记录2组患者左侧双腔支气管导管插管定位成功后平卧位双肺通气时(t1)、侧卧位双肺通气时(t2)、单肺通气10 min(t3)、单肺通气30 min(t4)的气道峰压(Ppeak)和脉搏氧饱和度(SpO2)。记录两组患者听诊有哮鸣音,发生支气管痉挛的例数。结果与T0时比较,两组患者T1时收缩压、舒张压下降(P<0.01);与T0时比较,T2时对照组收缩压、舒张压和心率上升(P<0.01);与对照组比较,T2时利多卡因组收缩压、舒张压和心率下降(P<0.01)。与对照组比较,t3、t4时利多卡因组气道峰压低(P<0.05)。结论2%利多卡因气管支气管表面麻醉,能抑制患者左侧双腔支气管导管插管的心血管应激反应,能降低单肺通气时的气道峰压。Objective To observe the safety and feasibility of lidocaine tracheobronchial surface anesthesia in left double-lumen bronchial intubation.Methods 70 patients with left double-lumen bronchial intubation under general anesthesia were selected and divided into lidocaine group and control group by random number table.Lidocaine group:after anesthesia induction,2%lidocaine was applied under fiberoptic bronchoscopy to perform surface anesthesia on the throat,glottis,trachea and left main bronchus,and then tracheal catheter was inserted.Control group:directly insert tracheal catheter after anesthesia induction.The systolic blood pressure(SBP),diastolic blood pressure(DBP),and heart rate(HR)of the patients in the two groups were observed and recorded before anesthesia(T0),before endotracheal intubation(T1),after left double-lumen bronchial intubation(T2),during lateral decubitus position(T3),and after 20 minutes of one-lung ventilation(T4).The peak airway pressure and pulse oxygen saturation(SpO2)of the two groups of patients were recorded at the time of bilateral pulmonary ventilation in the supine position(t1),bilateral pulmonary ventilation in the lateral position(t2),single-lung ventilation for 10 minutes(t3),and single-lung ventilation for 30 minutes(t4).The number of bronchospasm cases in the two groups was recorded.Results Compared with T0,systolic blood pressure and diastolic blood pressure decreased at T1 in the two groups(P<0.01).Compared with T0,systolic blood pressure,diastolic blood pressure and heart rate increased in the control group at T2(P<0.01).Compared with control group,systolic blood pressure,diastolic blood pressure and heart rate decreased in the lidocaine group at T2(P<0.01).Compared with the control group,the peak airway pressure depression in the lidocaine group at t3 and t4(P<0.05).Conclusion Endotracheal and bronchial surface anesthesia with 2%lidocaine can inhibit the cardiovascular stress response of patients with left double-lumen bronchial catheter intubation and reduce the peak airway pr

关 键 词：利多卡因 表面麻醉 双腔支气管导管 

分 类 号：R614[医药卫生—麻醉学]