盐酸利多卡因胶浆与复方利多卡因乳膏减少儿童全身麻醉喉罩拔除后咽部不良反应的效果比较  

Comparison of the efficacy of lidocaine hydrochloride gel paste versus compound lidocaine cream in alleviating pharyngeal adverse reactions in children after general anesthesia with laryngeal mask airway

作　　者：张雪梅 高铮铮 孙岚 王鑫宇 曹鑫鑫 王芳[1] 张建敏[1] 李立晶[1] Zhang Xuemei;Gao Zhengzheng;Sun Lan;Wang Xinyu;Cao Xinxin;Wang Fang;Zhang Jianmin;Li Lijing(Department of Anesthesiology,Beijing Children’s Hospital,Capital Medical University,National Center for Children’s Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院麻醉科,北京100045

出　　处：《临床小儿外科杂志》2024年第12期1180-1185,共6页Journal of Clinical Pediatric Surgery

摘　　要：目的观察盐酸利多卡因胶浆与复方利多卡因乳膏作为喉罩表面润滑剂,对于减少儿童全身麻醉喉罩拔除后咽部不良反应的效果。方法本研究为单中心前瞻性随机对照单盲研究,纳入2023年5月至2023年8月在首都医科大学附属北京儿童医院择期行漏斗胸矫治术后内固定物取出术的90例患儿作为研究对象,年龄8~15岁,美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级Ⅰ~Ⅱ级。按照随机数据表法将患儿分为两组:盐酸利多卡因胶浆组(L组,n=45)和复方利多卡因乳膏组(F组,n=45),两组术前分别均匀涂抹利多卡因胶浆、复方利多卡因乳膏于喉罩正反面。记录两组喉罩置入成功次数、置入成功时间及患儿入室时(T0)、喉罩置入即刻(T1)、拔除喉罩即刻(T2)的心率、平均动脉压。观察拔除喉罩即刻有无声音嘶哑、呛咳、喉痉挛、口咽黏膜炎,拔除喉罩后10 min、30 min、2 h、6 h的咽痛情况,拔除喉罩2 h内咽部不良反应发生情况。结果两组均置入顺利,血流动力学稳定。根据数字评定量表,拔除喉罩后10 min、30 min,L组咽痛发生率均低于F组,分别为16%(7/45)比38%(17/45)、8.9%(4/45)比26.7%(12/45),差异均有统计学意义(P<0.05);两组拔除喉罩后2 h和6 h咽痛程度比较,差异无统计学意义(P>0.05);拔除喉罩后2 h,L组咽部不良反应发生率低于F组[16%(7/45)比38%(17/45)],差异有统计学意义(P<0.05),其中保护性咽反射受限发生率比较,L组低于F组[6.7%(3/45)比22.2%(10/45)],差异有统计学意义(P<0.05)。结论使用盐酸利多卡因胶浆作为喉罩润滑剂,可降低儿童全身麻醉喉罩拔除后咽痛发生率,减少咽部不良反应,咽部保护性反射恢复快,有利于患儿加速康复。Objective To observe the efficacy of lidocaine hydrochloride gel paste versus compounded lidocaine cream as surface lubricants in reducing adverse pharyngeal reactions after general anesthesia by laryngeal mask in children.Methods For this single-center prospective single-blind randomized controlled study,90 children underwent elective removal of internal fixation after funnel chest surgery from May 2023 to August 2023.Aged 8 to 15 years with ASA classificationⅠ-Ⅱ,they were randomized into two groups of lidocaine hydrochloride gel paste(L,n=45)and compounded lidocaine cream(F,n=45).Specific medications were applied evenly to front and back of laryngeal mask preoperatively.Number of successful mask insertions,time of successful insertion,hemodynamic changes of heart rate(HR)and mean arterial pressure(MAP)at the time of entering operation room(T0),moment of laryngeal mask insertion(T1)and moment of laryngeal mask removal(T2)were recorded.The presence of hoarseness,choking,laryngospasm and oropharyngeal mucositis at the moment of removing mask;sore throat at 10 min,30 min,2h and 6h after removing mask;the occurrence of adverse pharyngeal reactions within 2h after removing mask were recorded.Results Based upon numerical rating scale(NRS),the incidence of sore throat in group L was lower than that in group F at 10 min after removing mask;and the incidence of sore throat was lower in group L than that in group F at 30 min[8.9%(4/45)vs.26.7%(12/45)]and the difference was statistically significant(P<0.05).The incidence of adverse pharyngeal reactions was lower in group L than that in group F[16%(7/45)vs.38%(17/45)]at 2 h after removing mask with a statistically significant difference(P<0.05).Regarding the incidence of protective pharyngeal reflex restriction,group L was lower than group F with[6.7%(3/45)vs.22.2%(10/45)]a statistically significant difference(P<0.05).Conclusions Usage of lidocaine hydrochloride gel paste as a laryngeal mask lubricant may lower the incidence of sore throat after mask removal and reduce

关 键 词：利多卡因 润滑剂 麻醉 全身 喉罩 不良反应 儿童 

分 类 号：R61[医药卫生—外科学]