四种药物合剂行鼻腔表面麻醉在纤维支气管镜引导经鼻清醒气管插管中的应用研究

Application of a four-drug-mixture for topical anesthesia during awake nasotracheal fiberoptic intubation

目的观察四种药物合剂在纤维支气管镜引导经鼻清醒气管插管患者中鼻腔表面麻醉的效果。方法采用前瞻性研究方法,选取2019年1月至2020年1月首都医科大学附属北京友谊医院收治的行口腔科手术的患者60例,按照随机数字表法将患者分为两组:两种合剂组(T组)和四种合剂组(F组),每组各30例。两组患者均以2%利多卡因行环甲膜穿刺后,T组患者使用2%利多卡因+1%麻黄碱浸润的棉棒进行鼻腔表面麻醉;F组患者使用石蜡油+2%利多卡因+1%麻黄碱+利多卡因乳膏浸润的棉棒进行鼻腔表面麻醉。鼻腔表面麻醉3 min后,经鼻置入气管导管,后经纤维支气管镜引导行气管插管。插管成功后妥善固定。观察以下指标:①生命体征:患者进入手术室平静状态下时(T0)和盲探插入的气管导管在通过鼻后孔时(T1)的心率(HR)、收缩压(SBP)、舒张压(DBP)和血氧饱和度(SpO2);②完成气管插管的时间;③鼻黏膜出血情况。结果T0时,两组患者的HR、SBP、DBP和SpO2比较,差异均无统计学意义(P>0.05);T1时,T组患者的HR[(86.90±8.04)]、SBP[(157.93±16.39)mmHg]、DBP[(83.10±6.34)mmHg]均较F组[(82.33±6.21)次/min、(146.83±14.75)mmHg、(79.73±4.65)mmHg]更高,差异均具有统计学意义(P<0.05);T组患者的SBP和DBP的变化幅度[(19.67±11.65)mmHg、(7.43±4.85)mmHg]较F组[(6.70±4.46)mmHg、(4.20±3.65)mmHg]变化更剧烈,差异均具有统计学意义(P<0.05);F组患者的插管时间[(60.61±27.63)s]比T组[(93.60±40.21)s]更短,差异具有统计学意义(P<0.05);F组患者中6例鼻黏膜出血(20.00%)较T组14例鼻粘膜出血(46.67%)少,差异具有统计学意义(P<0.05)。结论采用四种合剂行鼻腔表面麻醉,在纤维支气管镜引导经鼻清醒气管插管中能够减少血流动力学波动、缩短插管时间、减少鼻黏膜出血,操作简单,值得推广。

Objective To observe the effect of a four-drug-mixture on topical nasopharyngeal anesthesia during awake nasotracheal fiberoptic intubation.Methods In this prospective study,60 patients underwent surgery in stomatology department of Beijing Friendship Hospital,Capital Medical University from January 2019 to January 2020 were enrolled.The patients were randomly divided into two groups:two-drug-mixture group(group T),and four-drug-mixture group(group F),with 30 cases in each group.All the patients received thyrocricoid puncture with 2%Lidocaine.Then,T group used cotton bud with 2%Lidocaine+1%Ephedrine for topical nasopharyngeal anesthesia,while F group used liquid paraffin+2%Lidocaine+1%Ephedrine+Lidocaine cream for topical nasopharyngeal anesthesia.After 3 min of topical nasopharyngeal anesthesia,the tube was inserted into the nasal cavity.The tracheal intubation procedure was guided by fiexible bronchofiberscope,then the tube was properly fixed after successfully intubation.Observe the following indicators:①Vital sign:heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP)and percutaneous oxygen saturation(SpO 2)when the patient entered the operating room in a calm state(T0)and after blindly inserted the tube in nasal cavity(T1);②The time to complete the tracheal intubation procedure;③Nasal mucosa bleeding.Results At T0,there was no significant difference in HR,SBP,DBP and SpO2 between the two groups(P>0.05);at T1,the HR[(86.90±8.04)],SBP[(157.93±16.39)mmHg]and DBP[(83.10±6.34)mmHg]in group T are higher than those in group F[(82.33±6.21)times/min,(146.83±14.75)mmHg,(79.73±4.65)mmHg],and the differences were statistically significant(P<0.05);the changes of SBP and DBP in group T[(19.67±11.65)mmHg,(7.43±4.85)mmHg]were greater than those in group F[(6.70±4.46)mmHg,(4.20±3.65)mmHg],and the differences were statistically significant(P<0.05).The intubation time group F[(60.61±27.63)s]was shorter than that in group T[(93.60±40.21)s],and the difference was statistically significant(P<0.05);there were 6 cases(20.00%)of nasal mucosa bleeding in group F,less than 14 cases(46.67%)in group T,and the difference was statistically significant(P<0.05).Conclusion The use of four-drug-mixture for topical anesthesia during awake nasotracheal fiberoptic intubation can reduce hemodynamic fluctuation,shorten intubation time,and reduce nasal mucosa bleeding.The operation is simple and worth promoting.It is easy to operate and worth promoting.