达克罗宁胶浆对气管插管全麻患者围拔管期循环状况和咽喉部疼痛影响的多中心临床观察

The effects of dyclonine on circulation and throat pain during endotracheal extubation from general anesthesia: a multicenter clinical trial

目的 观察盐酸达克罗宁胶浆对气管插管全麻患者围拔管期循环状况和咽喉部疼痛的影响。方法择期行全麻手术（手术时间〈2 h）患者288例,ASAⅠ-Ⅱ级,随机分成4组。对照组将不含达克罗宁的空白胶浆8 m L含于咽喉部5 min,在气管导管前端1/3涂抹空白胶浆2 m L,均匀涂抹2次。含服组将1%达克罗宁胶浆8m L含于咽喉部5 min,在气管导管前端1/3涂抹空白胶浆2 m L,均匀涂抹2次。涂抹组将空白胶浆8 m L含于咽喉部5 min,气管导管前端1/3处涂抹1%达克罗宁胶浆2 m L,均匀涂抹2次。含服加涂抹组将达克罗宁胶浆8 m L含于咽喉部5 min,气管导管前端1/3处涂抹1%达克罗宁胶浆2 m L,均匀涂抹2次。观察并记录4组患者诱导前（T0）、手术结束前10 min（T1）、吸痰前（T2）、吸痰后（T3）、放气囊前（T4）、放气囊后（T5）、拔管后5 min（T6）、拔管后10 min（T7）、拔管后15 min（T8）、拔管后20 min（T9）各时间点的收缩压（SBP）、舒张压（DBP）和心率（HR）的变化,记录患者睁眼时间和拔管时间,记录屏气、放气囊时与苏醒期呛咳发生率及躁动评分,并于术后24 h和48 h随访其咽痛情况,询问咽喉部舒适度和满意度。结果 T2、T3、T4和T5时,涂抹组患者HR明显慢于对照组（P〈0.05）;T3时,涂抹组患者HR明显慢于含服组和含服加涂抹组（P〈0.05）。涂抹组睁眼时间明显长于对照组（P〈0.05）;含服组和涂抹组屏气发生率和重度屏气发生率均明显少于对照组（P〈0.05）;涂抹组苏醒期发生呛咳率明显少于对照组（P〈0.05）;4组患者术后24 h和48 h咽喉部疼痛比较,差异无统计学意义（P〉0.05）;含服组和涂抹组的满意度明显高于对照组（P〈0.05）,含服加涂抹组与含服组、涂抹组比较差异无统计学意义（P〉0.05）。结论 1%盐酸达克罗宁胶浆用于气管插管安全,2 h全麻手术插管前应用达克罗宁胶浆可稳定气管插管患者围拔管期循环状况,减少围拔管期屏气和呛咳的发生,提高中等时间手术患者的满意度,推荐气管导管涂抹达克罗宁胶浆法为好,可在临床选用。

Objective To observe the effects of Dyclonine on circulation and throat pain during endotracheal extubation from general anesthesia. Methods Two hundred and eighty - eight patients （ ASA grade I - II）, who undergone elective surgery （ less than 2 hours） under general anesthesia, were enrolled and randomly divided into four groups ： Group C （contract group）, Group H （Dyclonine containing group）, Group T （Dyclonine coated group）, and Group HT （Dyclo- nine containing and coated group）. The systolic blood pressure （ SBP）, diastolic blood pressure （DSP） and hart rate （HR） at TO （pre -anesthesia induction）, T1 （l0 rain before the end of the operation）, T2 （before sputum aspirating）, T3 （after sputum aspirating）, T4 （before air bag deflation）, T5 （after air bag deflation）, T6 （5 rain after endotracheal extubation）, T7 （10 rain after endotracheal extubation）, T8 （15 rain after endotracheal extubation）, and T9 （20 rain after endotracheal extubation） were recorded. The time of hearing the call to open eyes, the time of pulling out tracheal tube, the incidence of holding breath and choking cough, and agitation grading were observed. The throat pain 24 h and 48 h after operation, the throat comfort and satisfaction were surveyed. Results The HRs in Group T were significantly lower than those in Group C at T2, T3, T4, and T5 （ P 〈 0. 05 ）. The HRs in Group T were significantly lower than those in Group H and Group HT at T3. The time of hearing the call to open eyes of Group T was significantly longer than that of Group C, while that of Group HT was significantly shorter than those of group H and Group T （ P 〈 0. 05）. The incidences of holding breath and severe holding breath in Group H and Group T, and the incidence of choking cough during recovery period in Group T were significantly lower than those in Group C （ P 〈 0. 05 ）. There was no significant difference in the throat pain 24 h and 48 h after operation among the four groups. The throat satisfactions in Group H and Group T were significantly higher than that in Group C （P 〈 0. 05 ）. Conclusion Dyclonine hydrochloride for endotracheal intubation is safe. The application of Dyclonine before endotraeheal intubation in general anesthesia, which less than 2 hours, can maintain stable circulation in patients, in addition, Dyclonine reduces the incidence of holding breath and choking cough, and improves the satisfactions. The tracheal tube coated with Dyclonin is recommended.