套囊内预填充利多卡因对短小手术后咽喉部并发症的影响

Effect of Preloading Alkalinized Lidocaine in Endotracheal Tube Cuffs on the Complications of Throat After Brief Surgery

目的研究气管导管套囊内预填充碱化利多卡因能否减少短小手术后咽喉部并发症的发生率以及能否减缓拔管前后循环系统的剧烈波动。方法选择拟在全身麻醉气管插管下行妇科手术患者120例,应用数字法随机分成A组(空气组)、B组(生理盐水组)和C组(利多卡因组),每组40例。在插管之前,用10ml空气(A组)或10ml生理盐水(B组)或4ml 20%利多卡因溶液和6ml 5%碳酸氢钠溶液(C组)预填充导管套囊>90min。气管插管前立即清空套囊,插管后分别向套囊内注入预先准备好的相同的物质直到不漏气为准。记录患者一般情况,拔管前5min,拔管后5min内血压、心率的最高值;离开PACU时和拔管后6h的声音嘶哑、咳嗽、咽喉痛情况。结果 3组患者的一般情况,套囊内注射容量等比较,差异无统计学意义(P>0.05)。与拔管前相比,C组拔管后血压、心率的平均增高值比A组、B组显著降低(P <0.05)。在恢复室期间和拔管后6h,C组咽喉痛的发生率明显低于A组、B组(P<0.05)。而3组之间咳嗽、声嘶发生率比较,差异无统计学意义(P>0.05)。结论气管导管套囊内预填充碱化利多卡因不仅可以减轻手术时长<2h的手术术后喉咙痛的发生率,还可以降低拔管前后循环系统的剧烈波动。

Objective To study whether the preloading of alkalized lidocaine in the endotracheal tube cuffs can reduce the incidence of postoperative throat complications and whether it can slow down the severe fluctuation of circulatory system before and after extubation after surgeries lasting < 2 h. Methods A total of 120 patients undergoing gynecological surgery under endotracheal intubation were randomly divided into group A(air group), group B( normal saline group) and group C(lidocaine group), 40 cases in each group. Cuffs were prefilled >90 min before intubation with 10 ml of air(group A) or 10 ml of saline(group B) or 4 ml of 2% lidocaine solution and 6 mL of 5% sodium bicarbonate solution( Group C). Cuffs were emptied immediately before intubation. After intubation, endotracheal tube cuffs were injected into the same substance prefilled until there was no air leak. The maximum values of blood pressure and heart rate at5 min ago before extubation and in 5 min after extubation were recorded. Hoarseness, cough, sore throat were recorded when the patients left PACU and at the 6 h after extubation. Results The general conditions of the three groups, cuffs injection capacity were not statistically significant(P >0. 05). Compared with those before extubation, the average increase of systolic blood pressure, diastolic blood pressure and heart rate after extubation in group C were significantly lower than those in group A and group B(P <0.05). While in the recovery room and at the 6 h after extubation, the incidence of sore throat in group C was significantly lower than that in group A and group B( P <0. 05). There was no significant difference in the incidence of cough and hoarseness among the three groups( P >0.05). Conclusion The preloading of alkalized lidocaine in the endotracheal tube cuffs can not only reduce the incidence of postoperative sore throat, but also reduce the severe fluctuation of circulatory system before and after extubation after surgeries lasting less than 2 hours.