利多卡因辅助瑞芬太尼用于喉显微术无肌松诱导气管插管的疗效

Efficacy of lidocaine intraveously combined with remifentanil on endotracheal intubation without muscle relaxants during laryngeal microscopic surgery

目的探讨利多卡因辅助瑞芬太尼用于喉显微术无肌松诱导气管插管的疗效。方法75例喉显微术患者，采用随机数字表法将患者随机分为Ⅰ组（常规诱导）、Ⅱ组（瑞芬太尼）、Ⅲ组（利多卡因复合瑞芬太尼），每组25例。观察Viby—Mogenson评分、拔管时间和苏醒质量[运动活动评分（motor activity assessment scale, MAAS）]，记录T1（诱导前）、T2（插管前即刻）、T3（插管后即刻）平均动脉压（mean artery pressure，MAP）、心率（heartrate，HR）和T1、T4（拔管后即刻）血糖（blood glucose，Glu）、皮质醇（cortisol，Cor）浓度。结果3组Viby-Mogenson各项评分差异无统计学意义（P〉0．05）。Ⅱ组T2时MAP、HR为（64±7）mmHg（1mmHg=0．133kPa）、（61±6）次／min，明显低于Ⅰ组[（73±8）mmHg、（68±8）次／min]、Ⅲ组[（71±8）mmHg、（67±7）次／min]（P〈O．05）。Ⅲ组拔管时间和T4时MAAS评分分别为（6．4±2．4）min和（4．1±1．3），明显少于Ⅰ组[（15．6±3．7）min和（6．6±2．7）]、Ⅱ组[（7．9±2．6）min和（5．5±2．3）]（P〈0．05）.Ⅲ组T4时Glu和Cor浓度分别为（5．7±1．4）mmol／L和（0．77±0．68）mmo]／L，明显低于Ⅰ组[（7．7±1．7）、（0．98±0．54）mmol／L]、Ⅱ组[（7．5±1．6）、（0．97±0．49）mmol／L]（P〈0．05）。结论利多卡因辅助瑞芬太尼用于喉显微术无肌松诱导气管插管安全可靠，疗效好。

Objective To investigate the clinical effects of intravenous injection of lidocaine combined with remifentanil on tracheal intubation without muscle relaxants by for laryngeal microscopic surgery. Methods 75 ASA I -II patients undergoing laryngeal microscopic surgery for tracheal intubation without muscle relaxants were randomly divided into Group I （conventional induction）, group II （remifentanil）and group III （lidocaine combined with remifentanil）. These intubating conditions （Viby- Mogenson）, extubation time and awakening quality （movement activity score of the MAAS） were recorded. Mean arterial pressure （MAP） and heart rate （HR） were also recorded T1 （before induction） and T2 （immediately before） and T3 （after intubation）. Blood glucose（Glu） and cortisel（Cor） were tested at T2 and T4（extubation）. Results There was no significant difference in the scores of Viby- Mogenson（P〉0.05）. MAP[ （64±7） mm Hg]（ 1 mm Hg=0.133 kPa） and HR[ （61±6） bpm] in Group II were significantly lower than those in Group I [（73±8） mm Ug, （68±8） bpm], III [（71±8） mm Hg, （67±7） bpm] at T2 （P〈0.05）. Extubation time [（6.4±2.4） mini and MAAS score [ （4.1_±1.3）] at T4 in group III were significantly shorter than those in group I [ （15.6±3.7） min and （6.6±2.7）], I1 [（7.9±2.6） rain and （5.5±2.3）]（P〈0.05）. Glu [（5.7±1.4） mmol/L] and Cor [（0.77±0.68） mmol/L] in group m were significantly lower than those in group I [ （7.7±1.7）, （0.98±0.54） mmol/L], II [（7.5±1.6）, （0.97±0.49） mmol/L] at T4（P〈0.05）. Conclusions Tracheal intubation without muscle relaxants by intravenous injection of lidocaine combined with remifentanil for laryngeal microscopic surgery was safe and efficient.