利多卡因雾化吸入在口腔及咽喉部肿物患者纤维支气管镜插管中的应用

Application of lidocaine atomization inhalation in fiberoptic bronchoscopy intubation of patients with oral and throat tumor

目的观察利多卡因雾化吸入表面麻醉用于耳鼻喉科口腔及咽喉部肿物手术患者行纤维支气管镜引导气管插管的临床效果。方法选择2018年1月—2019年8月于秦皇岛市第一医院择期行口腔及咽喉部肿物切除术的患者80例,随机数字表法分为2组,对照组采用利多卡因喷喉加环甲膜穿刺法表面麻醉,观察组采用利多卡因雾化吸入法表面麻醉,2组患者均于插管前静脉泵入负荷剂量右美托咪啶1μg/kg,10 min泵注完毕。分别于患者入室后5 min(T 0)、插管即刻(T 1)、插管后1min(T 2)、插管后3min(T 3)记录SBP、DBP、SpO 2、HR的变化。记录插管时间,观察插管期间是否发生呛咳,有无发生喉痉挛,口腔黏膜有无损伤,术后24h随访患者对插管过程有无记忆,有无术中知晓,比较2组的麻醉效果。结果2组手术时间、麻醉时间比较差异均无统计学意义(t=1.252、1.570,P>0.05)。与对照组比较,观察组SBP、DBP、HR在T 2时明显降低,SpO 2明显升高,差异均有统计学意义(t/P=2.436/0.038、2.224/0.040、2.401/0.018、2.382/0.020),观察组的插管时间明显短于对照组(t=2.045,P=0.042),一次插管成功率明显高于对照组(100.0%vs.97.5%,χ^2=4.633,P=0.038)。观察组的呛咳反应、喉痉挛发生率明显低于对照组(7.5%vs.37.5%,χ^2=5.010,P=0.030;0 vs.5.0%,χ^2=4.252,P=0.041)。结论利多卡因雾化吸入法表面麻醉用于耳鼻喉科口腔及咽喉部肿物手术表面麻醉效果良好,能够更好地减轻插管时患者的心血管反应,有利于维持循环稳定,且安全性较好。

Objective To observe the clinical effect of lidocaine atomization inhalation on tracheal intubation guided by fiberoptic bronchoscope in otolaryngology and oral surgery.Methods From January 2018 to August 2019,80 patients undergoing oral and pharyngeal tumor resection in the first hospital of Qinhuangdao City were selected and randomly divided into two groups.The control group was given topical anesthesia with lidocaine spray and cricothyroid membrane puncture,while the observation group was given lidocaine atomization inhalation.Before intubation,the loading dose of dexmedetomidine was 1μg/kg,The pump was finished in 10 min.The changes of SBP,DBP,SpO 2 and HR were recorded at 5 min(T 0),immediately after intubation(T 1),1 min after intubation(T 2),and 3 min after intubation(T 3).The intubation time was recorded to observe whether there was cough,laryngeal spasm and oral mucosa injury during intubation.The patients were followed up 24 hours after operation for whether they had memory of intubation process and whether they knew during operation.The anesthetic effects of the two groups were compared.Results There was no significant difference in operation time and anesthesia time between the two groups(t=1.252,1.570,P>0.05).Compared with the control group,SBP,DBP,HR in the observation group were significantly lower at T 2,and SpO 2 was significantly higher(t/P=2.436/0.038,2.224/0.040,2.401/0.018,2.382/0.020),and the intubation time in the observation group was significantly shorter than that in the control group(t=2.045,P=0.042);the success rate of intubation in the observation group was significantly higher than that in the control group(100.0%vs.97.5%,χ^2=4.633,P=0.038).The incidence of choking reaction and laryngeal spasm in the observation group was significantly lower than that in the control group(7.5%vs.37.5%,χ^2=5.010,P=0.030;0 vs.5.0%,χ^2=4.252,P=0.041).Conclusion Lidocaine atomization inhalation topical anesthesia for otolaryngology oral and throat tumor surgery surface anesthesia effect is good,can better reduce the cardiovascular reaction of patients during intubation,is conducive to maintain circulation stability,and good safety.