1%丁卡因表面麻醉对全身麻醉支撑喉镜手术患者血流动力学的影响  

Effects of topical anesthesia with 1%tetracaine on hemodynamic responses in microlaryngosurgery

作　　者：魏征[1] 辛燕 吴黎黎[1] 奚春花[1] 王古岩 Wei Zheng;Xin Yan;Wu Lili;Xi Chunhua;Wang Guyan(Department of Anesthesiology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院麻醉科,北京100730

出　　处：《中华医学杂志》2022年第21期1590-1595,共6页National Medical Journal of China

基　　金：北京市医院管理中心临床医学发展专项(ZYLX202103)。

摘　　要：目的探讨1%丁卡因表面麻醉对全身麻醉支撑喉镜喉显微手术患者术中血流动力学的影响。方法选择2021年10至12月北京同仁医院全身麻醉支撑喉镜手术患者92例,男46例,女46例,年龄[M(Q1,Q3)]为51(42,57)岁。采用随机数字表法分为两组:丁卡因组(n=46):麻醉诱导后在舌根、会厌喉面、声门区喷入1%丁卡因1.5 ml,每点0.5 ml,共两次;对照组(n=46):用生理盐水代替丁卡因。分别记录两组患者入室安静后(基线)、诱导后、插管后、支撑喉镜悬吊固定即刻、支撑喉镜后1 min(上镜1 min)、支撑喉镜后3 min(上镜3 min)、支撑喉镜后5 min(上镜5 min)、拔管后的心率、平均动脉压(MAP);同时记录并分析两组患者苏醒期恢复指标(包括患者自主呼吸恢复时间、睁眼时间、拔管时间)以及不良反应发生情况。结果丁卡因组患者在基线、诱导后、插管后、支撑喉镜悬吊固定即刻、上镜1 min、上镜3 min、上镜5 min、拔管后的MAP分别为(99.4±12.9)、(78.5±8.8)、(79.2±10.2)、(100.6±17.0)、(101.9±14.7)、(100.8±13.9)、(97.4±12.1)、(107.3±16.8)mmHg(1 mmHg=0.133 kPa),对照组分别为(99.5±11.6)、(80.9±12.8)、(90.5±16.0)、(109.5±20.4)、(108.0±18.9)、(103.7±15.5)、(100.1±13.3)、(114.2±17.3)mmHg;对照组在插管后及支撑喉镜悬吊固定即刻的MAP高于丁卡因组(均P<0.05)。丁卡因组患者在基线、诱导后、插管后、支撑喉镜悬吊固定即刻、上镜1 min、上镜3 min、上镜5 min、拔管后的心率分别为(71.3±10.6)、(66.0±10.1)、(69.5±11.4)、(61.3±14.2)、(69.8±9.8)、(71.0±10.6)、(70.6±11.0)、(78.8±11.6)次/min,对照组分别为(73.1±10.9)、(67.8±9.9)、(79.5±12.9)、(57.1±18.1)、(69.2±12.8)、(71.4±11.7)、(70.7±11.5)、(85.3±13.0)次/min;对照组在插管后及拔管后的心率高于丁卡因组(均P<0.05)。两组患者自主呼吸恢复时间分别为(11.8±3.5)、(11.3±4.6)min,睁眼时间分别为(12.0±3.3)、(11.5±5.0)min,拔管时间分�Objective To observe the effects of topical anesthesia with 1%tetracaine on hemodynamic responses in general anesthesia patients undergoing microlaryngosurgery.Methods From October 2021 to December 2021,92 patients(46 males and 46 females)in Beijing Tongren Hospital,with a median age[M(Q1,Q3)]of 51(42,57)years who scheduled for microlaryngosurgery under general anesthesia,were divided into two groups(n=46 in each group)using the random number table method.Group T received topical anesthesia with 1%tetracaine at the root of the tongue and epiglottis and glottis on the basis of general intravenous anesthesia induction,with 0.5 ml at each position,while the control group(group C)received equal volume of normal saline.Heart rate(HR)and mean arterial pressure(MAP)were recorded at the time of patients entering the operating room(baseline),after induction,after intubation,immediately after suspending laryngoscopy,1 min after suspending laryngoscopy,3 min after suspending laryngoscopy,5 min after suspending laryngoscopy and immediately after extubation.The recovery profiles,including time to recover breathing,time to open eyes,time to extubation and adverse reactions were evaluated during recovery period.Results The MAP of patients in group T at baseline,after induction,after intubation,immediately after suspending laryngoscopy,1 min after suspending laryngoscopy,3 min after suspending laryngoscopy,5 min after suspending laryngoscopy and immediately after extubation were(99.4±12.9),(78.5±8.8),(79.2±10.2),(100.6±17.0),(101.9±14.7),(100.8±13.9),(97.4±12.1),(107.3±16.8)mmHg(1 mmH=0.133 kPa),respectively,while in group C were(99.5±11.6),(80.9±12.8),(90.5±16.0),(109.5±20.4),(108.0±18.9),(103.7±15.5),(100.1±13.3),(114.2±17.3)mmHg,respectively.The two critical time points of MAP after intubation and immediately suspending laryngoscopy in group C were significantly higher than group T(P<0.05).The HR of patients in group T at baseline,after induction,after intubation,immediately after suspending laryngoscopy,1 min

关 键 词：麻醉 丁卡因 支撑喉镜 喉显微手术 血流动力学 

分 类 号：R614[医药卫生—麻醉学]