表面麻醉对经喉罩插管患者血流动力学的影响

Study on influence of topical anesthesia on hemodynamic response during intubation through laryngeal mask

目的观察一次性喉麻管经喉罩行气道表面麻醉对全身麻醉患者经喉罩气管插管血流动力学的影响。方法前瞻性地选择首都医科大学附属北京友谊医院2016年10月至2017年4月收治的60例择期全身麻醉手术患者,美国麻醉医师协会(ASA)分级I～II级,按照随机数字表法分为试验组(使用喉麻管行利多卡因喷雾表面麻醉,Lido组)和对照组(使用喉麻管行生理盐水喷雾,NS组)各30例。观察两组麻醉诱导前(基础值,T1)、麻醉诱导后(T2)、置入喉罩即刻(T3)、插入气管导管即刻(T4),气管插管后l min(T5)、2 min(T6)、3 min(T7)、4 min(T8)、5 min(T9)的血压和心率。结果使用喉麻管行利多卡因喷雾表面麻醉组在经喉罩气管插管时和插管后各时间点的血压、心率与置入喉罩即刻、麻醉诱导后相比差异均无统计学意义(-0. 4 <t <1. 67,P> 0. 05),而使用喉麻管行生理盐水喷雾的NS组则显著升高(t=3. 82～4. 38,P <0. 05)。两组患者的血流动力学变化差异具有统计学意义(t=2. 47～3. 54,P <0. 05)。结论采用一次性喉麻管行气道表面麻醉可使经喉罩气管插管患者的血流动力学更为平稳。

Objective To observe the effect of topical anesthesia through a laryngeal mask on hemodynamic responses of endotracheal intubation through laryngeal mask.Methods A total of 60 patients undergoing elective surgery iundergeneral anesthesia with American Society of Anesthesiologist's(ASA)grades I to II during October 1st to April 30th in 2017 were selected prospectively from this hospital.According to the method of random number table,they were divided into two groups:topical anesthesia with lidocaine spraying group(Lido group,n=30)and control group(by using a laryngeal tube for saline spraying,NS group,n=30).Sixty patients with the American College of Anesthesiologists(ASA)I^II undergoing elective surgery under general anesthesia were selected.They were randomly divided into two groups:topical anesthesia on airway(Lido group)and control group(NS group).Blood pressure and heart rate were observed in these two groups before induction of anesthesia(basal value,T1),induction of anesthesia(T2),insertion of laryngeal mask immediately(T3),insertion of tracheal tube immediately(T4),and l-5 min after tracheal intubation(T5,T6,T6,T8,T9).Results There was no significant difference in blood pressure and heart rate in Lido group at intubation and after intubation through the laryngeal mask(-0.4<t<1.67,P >0.05).Intubation through laryngeal mask caused significant increase in blood pressure and heart rate in NS group compared to the value immediately after insertion of laryngeal mask or induction of anesthesia(4.38 >t >3.82,P<0.05).The difference in hemodynamic response between these two groups was statistically significant(3.54 >t >2.47,P<0.05).Conclusion The topical anesthesia on airway through a laryngeal mask can make hemodynamic response be more stable in endotracheal intubation through laryngeal mask.