甲哌卡因喉头和气管内喷注对老年患者气管插管反应的影响

Intubation Reaction of Mepivacaine for Laryngeal and Endotracheal Topical Anesthesia in Elderly Patients

目的:观察老年患者气管插管前2%甲哌卡因喉头和气管内表面麻醉对气管插管反应的影响。方法:60例拟行气管内插管全麻老年患者,60-78岁,ASA分级Ⅱ或Ⅲ级,按随机数字表法分为常规诱导组(对照组)、甲哌卡因表面麻醉组(试验组),每组各30例。两组均使用快速顺序诱导法,依次静脉推注咪达唑仑0.05 mg/kg、舒芬太尼0.2-0.4μg/kg、顺式阿曲库铵0.2 mg/kg、丙泊酚TCI 3-4μg/ml,试验组待肌松完全后在可视喉镜直视下使用一次性喉麻管对准会厌周围、声门及声门下气管内喷注2%甲哌卡因5 ml,继续面罩正压通气2 min后行气管插管术;对照组则在肌松完全后用可视喉镜行气管插管术。比较两组患者入手术室麻醉前(T0),全麻诱导后(T1),气管插管即刻(T2),气管插管后3 min(T3)的SBP、DBP及HR变化。结果:两组组间比较,T0、T1时的SBP、DBP及HR差异无统计学意义;试验组T2、T3时SBP、DBP及HR变化均较对照组小,差异有统计学意义(P<0.05)。结论:甲哌卡因喉头和气管内喷注能有效抑制老年患者气管插管反应,维持血流动力学稳定,使麻醉诱导期更平稳,值得推广应用。

Objective:To evaluate the intubation reaction of mepivacaine for laryngeal and endotracheal topical anesthesia in elderly patients. Methods:Sixty ASA Ⅱ or Ⅲ elderly patients(60-78 years old)with endotracheal intubation under general anesthesia were randomly divided into two groups(n=30 each):control group and mepivacaine administered intratracheally group. In the two groups,midazolam(0.05 mg/kg),sufentanil(0.2-0.4 μg/kg),cisatracurium(0.2 mg/kg),propofol TCI(3-4 μg/ml)were injected intravenously. And then 2% mepivacaine 5 mlwere injected into the mucosa around epiglottis,the glottis and the subglottic trachea under the visual laryngoscope in treatment group. The patients in the treatment group were accepted endotracheal intubation after 2 min positive pressure ventilation. The patients in the control group were accepted endotracheal intubation after general anesthesia induction. SBP,DBP and HR of the two groups were compared before anesthesia(T0),after induction of general anesthesia(T1),immediately after endotracheal intubation(T2),and 3 min after endotracheal intubation(T3). Results:There was no significant difference in SBP,DBP and HR between the two groups at the time of T0 and T1. The changes of SBP,DBP and HR at the time of T2 and T3 in the experimental group were smaller than in the control group(P<0.05). Conclusion:The laryngeal and intratracheal injection of mepivacaine can effectively inhibit the intubation reactionfor the elderly patientswith endotracheal intubation under general anesthesia,maintain the hemodynamic stability,and make the anesthesia induction period more stable,thus it is worthy being popularized and applied.