经注药型气管导管表面麻醉预防老年患者全麻苏醒期拔管反应  

Drug topical anesthesia via endotracheal tube for prevention of extubation response in elderly patients during recovery period of general anesthesia

作　　者：孙发发 姜兆舜 郑杨静 金鑫 董燕君 徐雯 顾卫东 赵丽亭 Sun Fafa;Jiang Zhaoshun;Zheng Yangjing;Jin Xin;Dong Yanjun;Xu Wen;Gu Weidong;Zhao Liting(Department of Anesthesiology,Huadong Hospital,Fudan University,Shanghai,200040,P.R.China;Department of Nursing,Huadong Hospital,Fudan University,Shanghai,200040,P.R.China)

机构地区：[1]复旦大学附属华东医院麻醉科,上海200040 [2]复旦大学附属华东医院护理部,上海200040

出　　处：《老年医学与保健》2025年第1期189-193,198,共6页Geriatrics & Health Care

摘　　要：目的观察经注药型气管导管注入1%利多卡因对老年患者苏醒期拔管反应的影响。方法2023年8月—2024年1月,复旦大学附属华东医院30例择期气管导管插管的老年全麻患者随机分至研究组(n=15)和对照组(n=15)。手术结束前,研究组经注药型气管导管注入1%利多卡因10 mL,对照组注入等容量0.9%生理盐水。主要观察指标为全麻苏醒期呛咳发生率,次要观察指标为全麻苏醒期呛咳严重程度、躁动发生率及其严重程度、苏醒期血流动力学变化、拔管时间和并发症等。结果与对照组相比,研究组拔管时呛咳发生率低于对照组(40.00%vs 93.33%,P=0.002),呛咳程度轻于对照组(P<0.05);研究组苏醒期躁动发生率低于对照组(13.33%vs 86.67%,P<0.001),躁动程度轻于对照组(P<0.05)。2组拔管即刻心率(HR)、平均动脉压(MAP)、收缩压(SBP),舒张压(DBP)差异有统计学意义(P<0.05),2组拔管前、拔管后5 min的HR、MAP、SBP和DBP差异无统计学意义(P>0.05)。2组拔管时间差异无统计学意义(P>0.05)。2组均未出现术后喉痉挛和肺部感染等并发症。结论经注药型气管导管注入1%的利多卡因可能有效预防老年患者全麻苏醒期拔管时呛咳反应,减轻血流动力学波动。Objective To observe the effects of 1%lidocaine injected into endotracheal tube on extubation response in elderly patients during recovery period.Methods From August 2023 to January 2024,30 elderly patients undergoing elective surgery under general anesthesia in Huadong Hospital Affiliated to Fudan University,were randomly divided into study group(n=15)and control group(n=15).Before the end of surgery,the study group received 10 mL of 1%lidocaine injected into endotracheal tube,while the control group received an equivalent volume of 0.9%NaCl.The primary observation index was the incidence of cough during the recovery period of general anesthesia,and the secondary observation indexes included the severity of cough,the incidence and severity of agitation,hemodynamic changes during recovery period,extubation time,and complications.Results Compared with the control group,the study group exhibited a lower incidence of cough(40.00%vs 93.33%,P=0.002)and milder cough severity(P<0.05)during extubation.The study group also showed a lower incidence of emergence agitation(13.33%vs 86.67%,P<0.001)and milder agitation severity(P<0.05).There were statistically significant differences in heart rate(HR),mean arterial pressure(MAP),systolic blood pressure(SBP),and diastolic blood pressure(DBP)between the two groups immediately after extubation(P<0.05).However,there was no statistically significant difference in HR,MAP,SBP and DBP between the two groups before extubation and 5 minutes after extubation(P>0.05).There was no statistically significant difference in extubation time between the two groups(P>0.05).Both groups did not experience postoperative complications such as laryngeal spasm and pulmonary infection.Conclusion The injection 1%lidocaine through endotracheal tube may effectively prevent cough reactions during extubation in elderly patients during general anesthesia recovery,and reduce hemodynamic fluctuations.

关 键 词：老年 全身麻醉 利多卡因 气管导管 苏醒期躁动 呛咳 

分 类 号：R61[医药卫生—外科学]