复方利多卡因乳膏涂抹气管导管行表面麻醉对改良悬雍垂腭咽成形术患者拔管反应的影响

Effect of topical anesthesia with compound lidocaine cream coated on the tracheal tube on extubation re- sponse in patients undergoing Han-uvulopharyngoplasty

目的评价复方利多卡因乳膏涂抹气管导管行表面麻醉对改良悬雍垂腭咽成形术（H—UPPP）患者拔管反应的影响。方法选择气管插管全麻下行H—UPPP患者84例，年龄28～48岁，体重91～108kg。采用随机数字表法，将患者随机分为2组（n=42）：复方利多卡因乳膏组（L组）和对照组（C组）。L组于麻醉诱导前气管导管套囊及前段均匀涂抹复方利多卡因乳膏2～3g，C组涂抹石蜡油。于麻醉诱导前5min、停止输注麻醉药、拔除气管导管、拔除气管导管后5min（T1-4）时记录MAP、HR和SpO2，并于各时点采集非输液侧前臂静脉血样3ml，检测血浆肾上腺素和去甲肾上腺素浓度，记录围拔管期间心血管事件的发生情况。结果与C组比较，L组T3,4时MAP及HR降低，高血压和心动过速的发生率降低，T2～4时血浆肾上腺素和去甲肾上腺素浓度降低（P〈0．05）。结论复方利多卡因乳膏涂抹气管导管表面麻醉可有效减轻H-UPPP患者拔管反应。

Objective To evaluate the effect of topical anesthesia with compound lidocaine cream coated on the tracheal tube on extubation response in patients undergoing Han-uvulopharyngoplasty （H-UPPP）. Methods Eighty-four patients, aged 28-48 yr, weighing 91-108 kg, scheduled for elective H-UPPP, requiring tracheal in- tubation under general anesthesia, were equally and randomly divided into 2 groups： compound lidocaine cream group （group L） and control group （group C）. The compound lidocaine cream 2-3 g were coated on the tracheal tube cuff and exterior before induction of anesthesia in group L, while the paraffin oil was coated in group C. Mean arterial pressure （MAP）, HR and pulse oxygen saturation were recorded before induction of anesthesia, at the end of infusion of anesthetics, during extubation and 5 min after extubation （T1-4） . Blood samples were taken from the forearm veins on the noninfusion side at T1-4 for detection of plasma adrenergic and norepinephrine concentrations. Cardiovascular events during extubation were recorded. Results Compared with group C, MAP and HR were sig- nificantly decreased at T3.4 , the incidences of hypotension and tachycardia were decreased, the plasma adrenergic and norepinephrine concentrations were significantly decreased at T2_4 in group L （ P 〈 0.05 ） . Conclusion Topi- cal anesthesia with compound lidocaine cream coated on the tracheal tube can effectively reduce the extubation re- sponse in the patients undergoing H-UPPP.