气管黏膜表面麻醉对插拔管应激反应和患者耐管的研究

Effect of tracheal mucosa surface anesthesia on tracheal intubation and extubation response and endurance of tracheal tubes

目的探讨气管黏膜表面麻醉对全麻插拔管应激反应和患者耐管的影响。方法将120例ASAⅠ～Ⅱ级妇科腹腔镜择期手术患者随机分为四组,每组30例,A组：气管导管套囊外涂抹2%利多卡因凝胶;B组：1%丁卡因5ml采用喉麻管气管内喷入（喉喷）;C组：2%利多卡因凝胶＋1%丁卡因喉喷;D组：为对照组,无任何表面麻醉。诱导方法：东莨菪碱0.3mg、咪达唑仑（咪唑安定）0.05mg/kg,芬太尼2μg/kg、维库溴铵0.08mg/kg、丙泊酚采用血浆靶控8μg/ml输注。观察指标：记录血压、心率在插管前、插管时、插管后1、3、5min的变化。抽血检测各组麻醉前、插管后5min、拔管后5min的皮质醇、血糖值。应用充放气进行耐管评定。结果各种表面麻醉方法在不同时点与D组比较都有不同程度减少循环波动的保护作用,差异有统计学意义（P〈0.05或P〈0.01）。四组间血糖、皮质醇比较差异无统计学意义（P〉0.05）。耐管评优率C组（66.7%）〉B组（36.7%）〉A组（33.3%）〉D组（10.0%）。A、B、C组与D组比较差异有统计学意义（P〈0.05或P〈0.01）。结论利多卡因凝胶＋丁卡因喉喷是最理想的表面麻醉方法。

Objective To investigate the effect of tracheal mucosal surface anesthesia on tracheal intubation response and endurance of tracheal tube in gynecological patients. Methods One hundred and twenty gynecological patients undergoing selective laparoscopic operations were randomly divided into 4 groups with 30 patients each group. Each patient was intubated with a tracheal tube smeared 2% lidocaine gel over its balloon in group A,with 1% dicaine sprayed intratracheally in group B,with a tracheal tube smeared 2% lidocaine hydrochloride gel over its balloon combined with 1% dicaine sprayed intratracheally in group C,in group D was no surface anesthesia as control group. Tracheal intubation was performed with scopolamine 0.3 mg,midazolam 0.05 mg/kg,fentanyl 2 μg/kg,vecuronium 0.08 mg/kg bromide and propofol at a fixed target plasma concentration of 8 μg/ml. Mean arterial pressure（MAP）and heart rate（HR）were recorded before and after intubation. Sera cortisone and blood glucose were measured before anesthesia induction,at 5 minutes after intubation and 5 minutes after extubation. Endurance of tracheal tubes was evaluated by puffing and deflating the balloons. Results There were much difference degrees on protection effection against decreasing blood pressure among three groups with control group（P〈0.05 or P〈0.01=. There were no difference in sera cortisone and blood glucose in patients of the 4 groups（P〉0.05）. In tolerane tube effection excellence rate high in group C （66.7%） than that in group B （36.7%）or group A（33.3%） and group D（10.0%）. There were significant differences in group C ,group B and group A than that in group D（P〈0.01 or P〈0.05=. Conclusions The most ideal methods of surface anesthesia is both 2% lidocaine hydrochloride gel and 1% dicaine laryngeal spray.