利多卡因乳膏对气管插管全身麻醉患者血流动力学和围拔管期应激反应的影响

To observe the effects of lidocaine cream on hemodynamics and stress response during extubation in patients with tracheal intubation under general anesthesia

目的探讨利多卡因乳膏对气管插管全身麻醉患者血流动力学和围拔管期应激反应的影响,为临床安全用药提供参考。方法选取2021年1月至8月在粤北人民医院80例接受全身麻醉择期手术(手术时间<3 h)的患者作为研究对象,按照随机数字表法将患者分为对照组、含服组、涂抹组和含服加涂抹组,每组20例。对照组患者未行利多卡因干预,含服组患者于咽喉部含服3 mL利多卡因乳膏3 min,涂抹组患者于气管导管套囊处涂抹3 mL利多卡因乳膏,含服加涂抹组患者于咽喉部含服3 mL利多卡因乳膏3 min,并在气管导管套囊处涂抹3 mL利多卡因乳膏。观察并记录4组患者入室后10 min(T_(0))、气管插管前1 min(T_(1))、气管插管即刻(T_(2))、气管插管后5 min(T_(3))、吸痰前(T_(4))、吸痰后(T_(5))、放气囊前(T_(6))、放气囊后(T_(7))、拔管后5 min(T_(8))时的心率(HR)和平均动脉压(MAP),并统计不良事件发生率。结果涂抹组患者在T_(4)、T_(5)、T_(6)、T_(7)时间点HR慢于对照组(P<0.05);含服加涂抹组患者在T_(2)、T_(3)、T_(4)、T_(5)、T_(6)、T_(7)、T_(8)时间点HR慢于对照组(P<0.05);涂抹组和含服加涂抹组患者放气囊时呛咳发生率明显小于对照组(P<0.05)。4组患者咽痛发生率比较,差异无统计学意义(P>0.05)。结论3 h内的全身麻醉手术应用利多卡因乳膏可有效抑制气管插管引起的血流动力学变化,减少围拔管呛咳的发生率。

Objective To investigate the effect of lidocaine cream on hemodynamics and stress response during periextubation in patients with tracheal intubation under general anesthesia,and to provide reference for clinical safe drug use.Methods 80 patients receiving elective surgery under general anesthesia(operation time less than 3 h)in Yue Bei People’s Hospital from January to August 2021 were selected as the research objects.The patients were divided into control group,taking group,smearing group and taking and smearing group by random number table,with 20 cases in each group.The control group did not receive lidocaine intervention,the taking group took 3 mL of lidocaine cream under the throat for 3 minutes,3 mL of lidocaine cream was applied to the tracheal tube cuff and evenly applied 3 times in the smearing group.3 mL of lidocaine cream was applied to the throat for 3 minutes,and 3 mL of lidocaine cream was applied to the tracheal tube cuff in the taking and smearing group.The heart rate(HR)and average arterial pressure(MAP)in the 10 min after entering the room(T_(0)),1 min before endotracheal intubation(T_(1)),immediately after endotracheal intubation(T_(2)),5 min after endotracheal intubation(T_(3)),before sputum aspiration(T_(4)),after sputum aspiration(T_(5)),before balloon release(T_(6)),after balloon release(T_(7)),5 min after extubation(T_(8))were calculated of the four groups.The adverse event rates were recorded.Results The changes of HR in smearing group at T_(4),T_(5),T_(6) and T_(7) time points were lower than those in control group(P<0.05).The changes of HR at T_(2),T_(3),T_(4),T_(5),T_(6),T_(7) and T_(8) time points were lower in the taking and smearing group than in the control group(P<0.05).The incidence of choking during balloon release was significantly lower in the smearing group and taking and smearing group than in the control group(P<0.05).There was no significant difference in the incidence of sore throat among the 4 groups(P>0.05).Conclusion Lidocaine cream can effectively inhibit the hemodynamic changes caused by tracheal intubation in general anesthesia operation within 3 hours,reduce the incidence of breath-holding,agitation and choking during peri-extubation.