不同方法气管内表面麻醉对拔管期老年患者血流动力学的影响

Hemodynamic Effects of Different Methods of Intratracheal Surface Anesthesia on Elderly Patients during Extubation

目的探讨不同方法气管内表面麻醉对拔管期老年患者血流动力学的影响。方法选择2012年6—12月老年择期手术60例,随机分为观察组和对照组,每组30例。手术结束前,观察组经连表麻型气管导管注药管注入盐酸利多卡因3 ml,对照组经普通气管导管口注入盐酸利多卡因3 ml,分别行喉、气管内表面麻醉。观察两组在拔出气管导管前1 min(T1)、拔出气管导管即刻(T2)、拔出气管导管后1 min(T3)和3 min(T4)时的血压、心率变化及拔管时呛咳的发生情况。结果观察组T2、T3时点血压和心率均低于对照组,对照组T2、T3时点血压和心率均高于T1时点,差异有统计学意义(P<0.05)。观察组呛咳控制满意率高于对照组,差异有统计学意义(P<0.05)。结论老年手术患者拔管前,通过连表麻型气管导管注药实施气管内表面麻醉,可有效抑制拔管操作诱发的心血管应激反应和呛咳。

Objective To explore hemodynamic effects of different methods of intratracheal surface anesthesia on elderly patients during extubation. Methods A total of 60 elderly patients undergoing selective operation from 2012 June to December were randomly divided into observation group （n = 30） and control group （n = 30）. Before the operation was finished, the observation group was injected with Lidocaine Hydrochloride 3 ml with surface anaesthetic tracheal tubes, while the control group was injected with Lidocaine Hydrochloride 3ml through endotracheal tubes. The throat and intratracheal surface anesthesia were performed respectively. Changes of blood pressure and heart rate （HR） 1 min before extubation （T1 ） , extubation （T2） , 1 min after extubation （T3） , 3 min after extubation （T4） in the two group and bucking reaction on T2 were observed. Results Levels of blood pressure and HR on T2 and T1 in observation group were significantly lower than those in control group, and in control group, levels of blood pressure and HR on T2 and T1 were significantly higher than that on TI （P 〈 0. 05）. The controlling satisfaction rate of bucking in observation group was significantly higher than that of control group （P 〈 0. 05）. Conclusion Administration of surface anaesthetic tracheal tubes before extubation can effective prevent cardiovascular stress reaction and bucking responses during extubation within trachea in elderly patients.