复方利多卡因乳膏气管内黏膜表面麻醉用于胸腔镜肺楔形切除术的价值

Value of eutectic mixture of local anesthetics cream in tratracheal mucosal surface anesthesia for thoracoscopic pulmonary wedge resection

目的:评价复方利多卡因(EMLA)乳膏气管内黏膜表面麻醉用于胸腔镜肺楔形切除术的临床应用价值。方法:回顾2013年1月至2016年1月在首都医科大学附属北京友谊医院择期全静脉麻醉下行胸腔镜肺楔形切除术的患者80例,根据术中是否使用EMLA乳膏分为观察组(40例)和对照组(40例)。观察组于术前在双腔气管插管大、小套囊处涂抹EMLA乳膏,对照组在套囊处以医用石蜡油润滑。回顾2组患者年龄、性别、美国麻醉医师协会分级等一般情况,术前(T 0)收缩压(SBP)、舒张压(DPB)、心率(HR),术中全身麻醉诱导插管后患者翻身侧卧(T 1)、肺楔形切除(T 2)、术毕恢复平卧(T 3)、拔除气管导管(T 4)时SBP、DBP、HR及气管导管移位时循环反应发生率、全身麻醉药用量、气管黏膜损伤情况,术后拔管期咳嗽情况及术后1 d随访情况。 结果:2组术中丙泊酚、舒芬太尼、罗库溴铵、瑞芬太尼用量比较差异均无统计学意义。观察组拔管期咳嗽发生率显著低于对照组(17.50%比55.00%, χ2=12.170, P<0.01)。观察组T 0、T 1、T 3时SBP、DBP与对照组比较差异均无统计学意义,T 2、T 4时SBP、DBP均显著低于对照组( P值均<0.05)。2组T 0、T 1、T 2、T 3、T 4时HR比较差异均无统计学意义。观察组气管导管移位时循环反应阳性发生率显著低于对照组(20.00%比60.00%, χ2=13.333, P<0.01)。2组患者术后1 d并未出现喘鸣、支气管痉挛、呼吸困难、喉痉挛、饮水呛咳等并发症。 结论:EMLA乳膏气管内黏膜表面麻醉用于胸腔镜肺楔形切除术中能有效减轻双腔气管导管移位时对气管内膜的刺激,降低拔管期咳嗽发生率及循环反应阳性发生率,且安全性较好。

Objective To evaluate the clinical value of eutectic mixture of local anesthetics(EMLA)in tracheal mucosal surface anesthesia for thoracoscopic pulmonary wedge resection.Methods Eighty patients received thoracoscopic pulmonary wedge resection under general anesthesia in Beijing Friendship Hospital,Capital Medical University from January 2013 to January 2016 were retrospected.They were divided into observation group(40 cases)and control group(40 cases)according to the use of EMLA.For observation group,EMLA was applied to the intubation cuffs of double-chamber trachea tube,while medical paraffin was applied for the control group.Data of two groups were analyzed,including general information such as age,gender,and American Society of Anesthesiologists classification,systolie blood pressure(SBP),diastolic blood pressure(DBP),and heart rate(HR)of preoperation(T1),turn to lateral position after intubation(T1),wedge resection(T2),return to supine position(T3),removing the endotracheal tube(T4),incidence of positive circulation reaction when the tracheal tube was displaced,general anesthetics dosage,the degree of injury in tracheal mucosa after extubation,cough during extubation,and.postoperative follow up.Results There was no significant difference in the dosage of propofol,sufentanil,rocuronium,and remifentanil between the two groups.The incidence of cough during extubation in the observation group was significantly lower than that in the control group(17.50%vs 55.00%,X°=12.170,P<0.01).There was no significant difference in SBP and DBP at T0,T1and T3,between the two groups,while SBP and DBP at T2 and T1 in the observation group were significantly lower than those in the control group(all P<0.05).There was no significant differencein HR at T0,T1,T2,T3 and T4,between the two groups.The incidence of positive circulation reaction when the tracheal tube was displaced in the observation group was significantly lower than that in the control group(20.00%vs 60.00%,χ2=13.333,P<0.01).There were no complications such as wheezing,bronchospasm,dyspnea,laryngospasm,and water choking in the two groups one day after operation.Conclusions EMLA cream intratracheal m ucosal surface anesthesia in thoracoscopic pulmonary wedge resection can effectively reduce stimulation of double lumen endotracheal tube,incidence of cough and positive circulation reaction during extubation with relatively high safety.