静脉注射和泵注利多卡因用于支撑显微喉镜下声带手术的临床效果

Clinical effect of intravenous injection and pump injection of lidocaine for supporting vocal cord surgery under microlaryngoscopy

目的观察静脉注射和泵注利多卡因用于支撑显微喉镜下声带手术的临床效果。方法选取2018年9月~2019年3月在海军军医大学附属长海医院择期行声带手术的患者60例。将患者随机分为利多卡因组(L组,n=30)和对照组(等容量生理盐水)(C组,n=30)。记录患者麻醉前(T1)、插管前即刻(T2)、插管时即刻(T3)、置入支撑喉镜时即刻(T4)、置入支撑喉镜后3min(T5)、麻醉苏醒拔管后即刻(T6)各时点的收缩压(SBP)、舒张压(DBP)和心率(HR)的变化情况;记录气管拔管时间、拔管时呛咳反应和拔管后咳嗽事件;记录患者术后Riker镇静-躁动评分和出麻醉后恢复室(PACU)时咽喉部的疼痛视觉模拟评分(VAS评分),以及恶心呕吐等不良反应发生情况。结果两组间性别构成、年龄、体重、手术时间的差异均无统计学意义(P均>0.05),两组患者在T1时SBP、DBP、HR差异无统计学意义(P均>0.05),两组患者T2时SBP、DBP、HR明显低于T1时(P<0.05)。对照组患者T3~T5时SBP、DBP、HR明显高于T2时(P<0.05);利多卡因组患者T3~T5时SBP、DBP、HR与T2时比较差异无统计学意义(P>0.05)。对照组患者T6时SBP、DBP、HR明显高于T1时;利多卡因组患者T6时SBP、DBP、HR与T1时比较无统计学意义(P>0.05)。两组患者气管拔管时间比较无统计学意义(P>0.05)。从拔除气管导管时不同呛咳评分和拔管后咳嗽事件所占比例比较,利多卡因组效果优于对照组(P<0.05)。利多卡因组患者术后Riker镇静-躁动评分明显低于对照组(P<0.05)。从出麻醉后恢复室(PACU)时咽喉部的疼痛视觉模拟评分(VAS评分)患者所占比例比较,利多卡因组效果优于对照组(P<0.05)。结论静脉注射和泵注利多卡因能明显减轻患者全麻气管插管和手术操作造成的心血管反应,稳定血流动力学,促进手术顺利进行及提高苏醒质量,也有利于降低支撑显微喉镜下声带手术后气管拔管时的呛咳、减少拔管后咳嗽事件和减轻气管拔管后咽喉部疼痛等不良反应。

Objective To observe the clinical effect of intravenous injection and pump injection of lidocaine for supporting vocal cord surgery under microlaryngoscopy.Methods 60 patients with vocal cord elective surgery in Changhai Hospital Affiliated to Naval Medical University from September 2018 to March 2019 were selected.The patients were randomly divided into the lidocaine group(group L,n=30)and the control group(equivalent volume of normal saline group(group C,n=30).The changes of systolic blood pressure(SBP),diastolic blood pressure(DBP),and heart rate(HR)before anesthesia(T1),immediately before intubation(T2),immediately at intubation(T3),immediately after insertion of supporting laryngoscope(T4),3 minutes after insertion of supporting laryngoscope(T5),immediately after anesthesia recovery and extubation(T6)were recorded;the tracheal extubation time,choking reaction during extubation,and cough events after extubation were recorded;the Riker sedation-agitation scale(SAS)and the visual analogue scale(VAS)scoreof throat at post-anaesthesia care unit(PACU),and the occurrence of adverse reactions such as nausea and vomiting were recorded.Results There was no significant difference in gender,age,body weight,and operation time between the two groups(P>0.05).There was no significant difference in SBP,DBP and HR between the two groups at T1(P>0.05).The SBP,DBP,and HR at T2 in both groups were significantly lower than those at T1(P<0.05).The SBP,DBP,HR at T3~T5 in the control group were significantly higher than those at T2(P<0.05).There was no statistically significant difference in SBP,DBP,HR between T2 and T3~T5 in the L group(P>0.05).The SBP,DBP and HR of thegroup C at T6 were significantly higher than those at T1;there was no difference in SBP,DBP,HR between T6 and T1 in the L group(P>0.05).There was no difference in time of tracheal extubation between the two groups(P>0.05).The effect of L group was better than that of the group C in the choking scores when the tracheal tube was removed and the proportion of coughing events after extubation(P<0.05).The postoperative Riker SAS score in the L group was significantly lower than that in the group C(P<0.05).The effect of L group was better than that of the group C from the proportion of VAS score of throat after PACU(P<0.05).Conclusion Intravenous injection and pump injection of lidocaine can significantly reduce the cardiovascular response caused by general anesthesia and tracheal intubation and surgical procedures,stabilize hemodynamics,promote smooth operation and improve the quality of recovery.In addition,it can also help to reduce the adverse reactions such as choking during tracheal extubation after supporting vocal cord surgery under microlaryngoscopy,coughing events after extubation,and relieve throat pain after tracheal extubation.