奥布卡因凝胶预防鼻内镜术后苏醒期躁动的前瞻性随机对照研究

A Prospective Randomized Controlled Study on Oxybuprocaine Hydrochloride Gel for Prevention of Emergence Agitation After Nasal Endoscopy

目的探讨奥布卡因凝胶预防鼻内镜术后苏醒期躁动的有效性。方法采用前瞻性研究,选择2019年9月~2020年9月ASAⅠ~Ⅱ级择期全麻鼻内镜手术80例,随机分为奥布卡因组和对照组,每组40例。奥布卡因组术前将2 ml 0.3%盐酸奥布卡因凝胶涂抹气管导管套囊及前端15 cm范围内,对照组涂抹等量生理盐水,2组均进行常规麻醉诱导、气管插管。记录2组苏醒期躁动及严重程度,记录术中低血压、心动过缓、高血压、心动过速、体动等不良反应情况。结果奥布卡因组发生苏醒期躁动的比例显著低于对照组[10.0%(4/40)vs.37.5%(15/40),χ^2=8.352,P=0.004],且程度更轻[无、轻度、中度、重度分别为36、4、0、0例vs.25、7、5、3例,Z=-3.051,P=0.002]。奥布卡因组发生术中低血压[22.5%(9/40)vs.47.5%(19/40),χ^2=5.495,P=0.019]及心动过缓[7.5%(3/40)vs.27.5%(11/40),χ^2=5.541,P=0.019]的比例显著低于对照组。结论奥布卡因凝胶可以有效预防鼻内镜术后苏醒期躁动。

Objective To observe the effects of oxybuprocaine hydrochloride gel in preventing emergence agitation in patients after nasal surgery.Methods From September 2019 to September 2020,80 patients with ASAⅠ-Ⅱundergoing elective nasal surgery were randomly divided into 2 groups:oxybuprocaine hydrochloride gel group and control group.Each group consisted of 40 patients.In the oxybuprocaine group,2 ml 0.3%oxybuprocaine hydrochloride gel was applied to the endotracheal catheter cuff and the front end within 15 cm before surgery,followed by routine anesthesia induction and endotracheal intubation.In the control group,the endotracheal cannulas and the front end were applied with normal saline before operation,followed by routine anesthesia induction and endotracheal intubation.The incidence of emergence agitation and severity in the two groups were recorded.The occurrence of adverse reactions such as intraoperative hypotension,bradycardia,hypertension,tachycardia and body movement during recovery were recorded.Results The incidence of emergence agitation in the oxybuprocaine group were significantly lower than the control group[10.0%(4/40)vs.37.5%(15/40),χ^2=8.352,P=0.004].The degree of emergence agitation was more mild[none,mild,moderate and severe were 36,4,0,0 vs.25,7,5,3 cases,respectively,Z=-3.051,P=0.002].The rate of hypotension[22.5%(9/40)vs.47.5%(19/40),χ^2=5.495,P=0.019]and bradycardia[7.5%(3/40)vs.27.5%(11/40),χ^2=5.541,P=0.019]were lower than control group.Conclusion Oxybuprocaine hydrochloride gel can effectively prevent emergence agitation after nasal endoscopy.