利多卡因减少口腔颌面术后留置人工气道患者呛咳反射并降低飞沫传播风险的研究  

Study for lidocaine administrated to remission of cough reflex and reducing the potential risk of droplet transmission in patients with artificial airway after oral and maxillofacial surgery

作　　者：徐志侠[1] 丁书缘 陈志峰[1] 孙璐璐[1] XU Zhi-xia;DING Shu-yuan;CHEN Zhi-feng;SUN Lu-lu(Surgical Intensive Care Unit,Shanghai Ninth People's Hospital Affiliated Shanghai Jiaotong University School of Medicine,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院外科监护室,上海200011

出　　处：《世界临床药物》2020年第12期973-977,共5页World Clinical Drug

摘　　要：目的研究利多卡因静脉注射及气管表面麻醉能否降低口腔颌面术后留置人工气道患者的呛咳发生率和严重程度,减少此类患者的飞沫传播风险。方法将口腔颌面术后留置人工气道≥12 h的患者95例,随机分为利多卡因静脉注射组(I组,32例,1.5 mg/kg负荷剂量静注,随后每小时1.5 mg/kg泵注12 h)、利多卡因表面麻醉组(S组,32例,每2 h通过人工气道喷注利多卡因气雾剂两次,每次间隔5 min,每次2喷)和对照组(C组,31例,静脉注射等同I组剂量的生理盐水)。每小时记录收缩压、舒张压、平均动脉压、心率、呼吸频率、Richmond躁动-镇静量表(Richmond agitation-sedation scale,RASS)、咽喉疼痛视觉模拟评分(visual analogue scale,VAS)、切口痛VAS以及恶心呕吐次数。记录每小时的呛咳次数,并对每次呛咳进行分级。结果Ⅰ组和S组呛咳次数比C组少(P<0.05);Ⅰ组呛咳次数比S组少(P<0.05)。I组和S组等级0、2和3的呛咳次数比C组少(P<0.05);其中Ⅰ组等级1的呛咳次数比C组少(P<0.05);Ⅰ组等级0、1和2的呛咳次数比S组少(P<0.05)。I组和S组咽喉痛VAS评分比C组低(P<0.05);I组咽喉痛VAS评分比S组低(P<0.05)。Ⅰ组切口疼痛VAS评分低于S组和C组(P<0.05)。Ⅰ组和S组恶心呕吐次数及呼吸频率少于C组(P<0.05)。结论利多卡因静脉注射及气管表面麻醉均能有效改善口腔颌面术后留置人工气道患者的呛咳频率和严重程度,其中静脉注射效果更佳。Objective To investigate whether intravenous lidocaine and endotracheal tube surface anesthesia could reduce the incidence and severity of cough in patients with artificial airway after oral and maxillofacial surgery,so as to reduce the potential risk of droplet transmission among the patients.Methods A total of 95 patients with artificial airway(timing≥12 h)after oral and maxillofacial surgery were randomly divided into intravenous lidocaine group(group Ⅰ,included 32 cases,1.5 mg/kg bolus dose at once and 1.5 mg/kg per hours infusion continued to 12 h),and the lidocaine endotracheal tube surface anesthesia group(group S,included 32 cases,lidocaine aerosol sprayed twice every 2 h through artificial airway at an interval of 5 min,2 sprays each time),control group(group C,included 31 cases,given injection of saline at same dose of group Ⅰ).Systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),heart rate(HR),respiratory rate(RR),richmond agitation-sedation scale(RASS),sore throat visual analogue scale(VAS),incision pain VAS,as well as the frequency of nausea and vomiting were recorded per hour,the incidence of coughing occurred in one hour would be recorded and classified.Results The total number of cough occurred in group Ⅰ and group S were reduced in comparison with group C(P<0.05).Furthermore,group Ⅰ was less than group S(P<0.05).Degree 0,2 and 3 of coughing in group Ⅰ and group S were significantly decreased than group C(P<0.05),and the same as degree 1 in group I(P<0.05).The times of cough degree 0,1 and 2 in group S were much more than group Ⅰ(P<0.05).Sore throat VAS occurred in group Ⅰ and S had obviously decreased than group C,and group Ⅰ was lower than group S(P<0.05).Compared with group C and S,incision pain(VAS scale)in group Ⅰ was reduced(P<0.05).Compared with group C,the numbers of nausea and vomiting and RR were reduced in group Ⅰ and group S(P<0.05).Conclusion Lidocaine intravenous and surface anesthesia through artificial airway can effectively r

关 键 词：呛咳 利多卡因 人工气道 口腔颌面手术 

分 类 号：R782[医药卫生—口腔医学] R971.2[医药卫生—临床医学]