气管表面麻醉对血流动力学变化和呛咳反射的影响

Effect of Topical Anesthesia to Tunica Mucosa Tracheae on Hemodynamics Fluctuation and Bucking Incidence

目的 观察全麻拔管时气管表面麻醉对血流动力学变化和呛咳反射的影响。方法 ASAⅠ-Ⅱ级行上腹部手术患者50例，随机分为试验组和对照组，每组各25例。在手术结束前未减浅麻醉时，试验组将2％利多卡因5ml注入气管导管内，对照组将生理盐水5ml注入气管导管内。观察拔除气管导管前、拔管后1、2、3、5、10min时血流动力学改变，拔管吸痰时呛咳的发生率。结果 与对照组比较，实验组患者在拔管前，拔管后1～5min SBP、SDP、HR明显低于对照组，差异有统计学意义（P〈0．05）。对照组拔管前及拔管后5min内与拔管后10min时相比，血压和心率有明显升高，差异有统计学意义（P〈0．05）。试验组围拔管期中、重度呛咳率是8％，对照组是68％，差异有统计学意义（P〈0．05）。结论 气管黏膜表面麻醉可以减轻全麻苏醒期拔管时血流动力学的波动及降低患者呛咳和烦躁的发生率。

Objective To observe the effect of topical anesthesia to tunica mucosa tracheae on the hemodynamics fluctuation and bucking incidence during the period of tracheal extubation. Methods 50 ASA Ⅰ-Ⅱ patients without hypertension under abdominal surgery, aged 30 -50,were randomly divided into two groups（ each group 25 cases）. Before awake from anesthesia, patients in tri- al group were given 5ml 2% lidocaine intratracheally and control group were given 5ml normal saline intratracheally. Results The bucking incidence was 8% （2/25）in trial group, whereas it was 68% （17/25）in control group, being significant difference between the two groups （ P 〈0. 05）. In trial group, the blood pressure and heart rate show no significant difference during the period of tracheal extubation （ P 〉0. 05）. In control group, there were sharply increases in SBP,SDP,HR before trachea extubation and at 1 min, 2min, 3min, 5min after trachea extubation, compared with that at 10min after trachea extubation. （ P 〈 0.05）. Conclusion The bucking incidence and hemodynamics fluctuation during the period of tracheal extubation can be reduced effectively due to the topical anesthesia to the tunica mucosa tracheae.