喉及气管内表面麻醉对大脑幕上肿瘤切除术后拔管期呛咳的影响  

Effect of laryngeal and tracheal internal surface anesthesia on cough during extubation after supratentorial tumor resection

作　　者：陈永杰 梁剑峰 刘鲲鹏 张华[3] 汤义 赵欣 姚兰 Chen Yong-Jie;Liang Jian-Feng;Liu Kun-Peng;Zhang Hua;Tang Yi;Zhao Xin;Yao Lan(Department of Anesthesiology,Peking University International Hospital,Beijing 102206,China;Department of Neurosurgery,Peking University International Hospital,Beijing 102206,China;Research Center of Clinical Epidemiology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学国际医院麻醉科,北京102206 [2]北京大学国际医院神经外科,北京102206 [3]北京大学第三医院临床流行病学研究中心,北京100191

出　　处：《解放军医学杂志》2023年第3期318-322,共5页Medical Journal of Chinese People's Liberation Army

基　　金：科技创新2030-“脑科学与类脑研究”重大项目(2021ZD0204300);北京大学国际医院院内科研基金重点项目(YN2018ZD01);吴阶平医学基金会临床科研专项(320675018318)。

摘　　要：目的 探讨喉及气管内表面麻醉对大脑幕上肿瘤切除术后拔管期呛咳的影响及安全性。方法 选取2021年3月-2022年3月于北京大学国际医院行大脑幕上肿瘤切除术的40例患者作为研究对象,随机分为丁卡因组(n=20)与对照组(n=20)。丁卡因组插管前使用雾化型喉麻管将2 ml 2%丁卡因均匀喷洒于两侧声带、会厌及气管内,对照组不进行此干预,术中两组采取相同的麻醉管理。记录两组拔管时呛咳反应评分、拔管后咽部静息痛NRS评分、手术切口疼痛NRS评分,动脉置管完成3 min时(T0)、置入气管插管前(T1)、插管完成套囊充气后30 s(T2)、患者清醒达拔管条件拔除气管插管时(T3)的平均动脉压(MAP)、心率,以及拔管后声音嘶哑、吞咽呛咳的发生情况。结果 两组各有5例患者脱落。丁卡因组拔管时呛咳反应评分低于对照组[(0.4±0.6)分vs.(2.6±0.5)分],两组差值(95%CI)为±2.2(±2.5,±1.9),低于有效假设数值±1.8。丁卡因组拔管后咽部静息痛NRS评分明显低于对照组[2(0,2)分vs. 4(3,4.5)分,P<0.001],但两组手术切口疼痛NRS评分比较差异无统计学意义[3(2,3)分vs. 3(2.5,3.5)分,P=0.705]。丁卡因组T3时MAP明显低于对照组[(90.87±13.37) mmHg vs.(102.8±11.52) mmHg,P=0.014];T0-T3时,两组心率比较差异无统计学意义(P>0.05)。两组术后均未发生声音嘶哑、吞咽呛咳等不良反应。结论 在幕上肿瘤切除术气管插管前使用2%丁卡因进行喉及气管内表面麻醉,可降低拔管时的呛咳程度,缓解拔管后咽部疼痛,拔管时血压更平稳,且未见严重不良反应。Objective To investigate the effect of laryngeal and endotracheal surface anesthesia on cough reflex during extubation after excision of supratentorial tumors,and observe its safety.Methods Forty patients were recruited in present study who underwent supratentorial tumor resection under general anesthesia in the Department of Neurosurgery,Peking University International Hospital from March 2021 to March 2022.The patients were randomly divided into tetracaine group(n=20)and control group (n=20). Patients in tetracaine group were uniformly sprayed 2 ml of 2% tetracaine on the bilateral vocal cords, epiglottis and trachea with an atomized laryngeal anesthetic tube before intubation, and patients in control group received no such treatment Anesthesia management was the same in the both groups. Cough score during extubation, NRS score for throat pain after extubation, NRS score for incision pain, mean arterial pressure (MAP) and heart rate were recorded at 3 min after arterial intubation (T0), before tracheal intubation (T1), 30 s after pulling the cuff after intubation (T2), and when the patient is conscious enough to pull out the tracheal intubation (T3), and the occurrence of hoarseness, swallowing and coughing after extubation. Results Five patients in each group were excluded. The cough score was significantly lower in tetracaine group than in control group (0.4±0.6 vs. 2.6±0.5). Their difference was -2.2 (95%CI -2.5, -1.9), lower than the valid assumed value -1.8. NRS score of throat pain in tetracaine group was significantly lower than control group after extubation [2(0, 2) vs. 4(3, 4.5), P<0.001]. However, no statistically significant difference existed between the two groups in NRS scores of incision pain [3(2, 3) vs. 3(2.5, 3.5), P=0.705]. The MAP was significantly lower in tetracaine group than in control group at T3 [(90.87±13.37) mmHg vs. (102.8±11.52) mmHg, P=0.014];At T0-T3, there was no significant difference in heart rate between the two groups (P>0.05). No side effects such as hoarseness, swallo

关 键 词：表面麻醉 丁卡因 开颅手术 拔管期 呛咳 

分 类 号：R739.41[医药卫生—肿瘤] R614.21[医药卫生—临床医学]