复方利多卡因乳膏联合麻醉诱导前心理干预在喉罩全麻骨科内固定取出术中的临床观察

Clinical observation of compound lidocaine cream combined with preoperative psychological intervention on laryngeal mask in general anesthesia for orthopaedics internal fixation removal surgery

目的：观察复方利多卡因乳膏联合麻醉诱导前心理干预对喉罩全麻骨科内固定取出术患者围术期血流动力学、麻醉复苏效果及术后并发症的影响。方法：喉罩全麻下实施骨科内固定取出手术患者120例,ASAⅠⅡ级,随机分为4组（n=30）：对照组（C组）、复方利多卡因乳膏处理组（L组）、麻醉诱导前心理干预组（X组）和复方利多卡因乳膏＋麻醉诱导前心理干预组（LX组）。飞利浦多功能监测仪连续监测心率（heart rate,HR）、脉搏血氧饱和度（surplus pulse O2,SpO2）及血压（blood pressure,BP）,分别记录患者以下各个时间点的SpO2、平均动脉压（mean arterial pressure,MAP）及HR：入室后麻醉诱导前的基础值（T0）,喉罩置入时（T1）,喉罩置入后1 min（T2）、5 min（T3）,患者苏醒时（T4）,苏醒后拔除喉罩时（T5）,拔除喉罩后1 min（T6）、5 min（T7）、10 min（T8）。观察并记录患者术后至苏醒拔除喉罩的时间、拔除喉罩时的配合程度、躁动分级及术后不良反应发生率。结果：L组、X组及LX组患者麻醉苏醒期对喉罩刺激反应程度显著低于C组（P〈0.05）,尤以LX组降低为甚（P〈0.01）,且患者在苏醒期血压、心率也较稳定。L组、X组及LX组患者拔除喉罩时配合程度、术后满意度显著高于C组,喉罩拔除时间显著缩短、术后并发症发生率显著降低（P〈0.05）,尤以LX组为佳（P〈0.01）;与同时间点的L组及X组比较,LX组T4T8时间点MAP显著降低,更为稳定,03级躁动情况存在显著性差异（P〈0.05）,术后咽喉部不适、疼痛、声音嘶哑等并发症发生率显著降低（P〈0.05）。结论：复方利多卡因乳膏联合麻醉诱导前心理干预能有效抑制喉罩全麻患者苏醒期躁动及心血管应激反应,缩短喉罩拔除时间,降低术后并发症的发生率,保障了骨科内固定取出术喉罩全麻患者围术期生命安全。

Objective： To observe the effect of compound lidocaine cream combined with preoperative psychological intervention on perioperative hemodynamics,anesthesia recovery and postoperative complications in patients with laryngeal mask airway general anesthesia. Methods： 120 ASA Ⅰ or Ⅱ patients undergoing orthopaedics internal fixation removal operation under general anesthesia were randomly allocted into four groups（ n = 30） ： control group（ C group）,compound lidocaine cream treatment group（ L group）,preoperative psychological intervention group（ X group） and compound lidocaine cream plus preoperative psychological intervention group（ LX group）. Philips multifunction monitor continuous monitoring of heart rate（ HR）,surplus pulse O2（ SpO2） and blood pressure（ BP）.Recorded Sp O2,mean arterial pressure（ MAP） and HR respectively at various time points： the baseline when entering the operation room（ T0）,when laryngeal mask inserting（ T1）,1 min after laryngeal mask inserting（ T2）,5 min after laryngeal mask inserting（ T3）,when the patient awake（ T4）,when pulling out the laryngeal mask airway（ T5）,1 min after pulling out the laryngeal mask airway（ T6）,5 min after pulling out the laryngeal mask airway（ T7）,10 min after pulling out the laryngeal mask airway（ T8）. The time of postoperative recovery,degree of coordination and agitation,the incidence of postoperative adverse reaction such as sore throat or throat discomfort were monitored and recorded. Results： Compared with group C,the degree of stimulation were significantly lower in group L,group X and group LX（ P 〈 0. 05）,especially in group LX（ P 〈 0. 01）,and the blood pressure and heart rate were more stable during the recovery period; the coordination degree and postoperative satisfaction in group L,group X and group LX were significantly higher than that in group C,the time of pulling out the laryngeal mask airway was significantly shortened,postoperative complication rate was decreased significantly（ P 〈 0. 05）,especially in group LX（ P 〈 0. 01）; compared with the same time point of group L and group X,MAP at T4-T8 was significantly lower and more stable in group LX,the agitation had significant difference at 0-3 grades（ P 〈 0. 05）. Postoperative throat discomfort,pain,hoarseness and other complications were decreased significantly in group LX（ P 〈 0. 05）.Conclusion： Compound lidocaine cream combined with preoperative psychological intervention can effectively inhibit postoperative agitation and cardiovascular adverse reaction,shorten the extraction time of laryngeal mask airway,reduce the incidence of postoperative complications,provide safety for the patients during the laryngeal mask airway general anesthesia perioperative period for orthopaedics internal fixation removal surgery.