丁卡因表面麻醉对喉显微手术拔管反应的影响

Effects of tetracaine topical anesthesia on extubation responses in laryngeal microsurgery

目的探讨丁卡因表面麻醉对喉显微手术全身麻醉苏醒期呛咳反应及血流动力学的影响。方法选取2021年9—10月首都医科大学附属北京同仁医院择期全身麻醉下行喉显微手术的患者60例,采用随机数字表法分为丁卡因组(T组)和对照组(C组),每组30例。T组麻醉诱导后在可视喉镜明视下应用一次性喷雾器对会厌、声门区喷入1%丁卡因1.5ml,共2次;C组应用生理盐水代替。记录两组患者苏醒期拔管呛咳的发生率及严重程度、血流动力学变化、苏醒期恢复质量和不良反应发生情况。结果C组苏醒期拔管呛咳发生率(80.0%)、中重度呛咳发生率(40.0%)明显高于T组(46.7%、10.0%),差异均有统计学意义(P<0.05)。T组拔管后即刻MAP[(108.4±18.0)mmHg,1 mmHg=0.133 kPa]和HR[(79.1±12.0)次/min]显著低于C组[(118.9±20.4)mmHg,(85.8±12.6)次/min],差异均有统计学意义(P<0.05)。两组自主呼吸恢复时间、睁眼时间、拔管时间和术后躁动评分比较,差异均无统计学意义(P>0.05)。两组均未发生相关不良反应。结论1%丁卡因表面麻醉能显著降低全身麻醉苏醒期呛咳的发生率及严重程度,减少血流动力学波动,且不影响全身麻醉苏醒质量,不增加不良反应发生率。

Objective To investigate the effects of tetracaine topical anesthesia on cough response and hemodynamics during recovery from general anesthesia in laryngeal microsurgery.Methods A total of 60 patients undergoing elective laryngeal microsurgery under general anesthesia in Beijing Tongren Hospital,Capital Medical University from September to October 2021 were selected.The patients were divided into tetracaine group(group T)and control group(group C)by random number table method,30 cases in each group.In group T,1.5 ml 1%tetracaine was sprayed on into epiglottis and glottis area with a disposable nebulizer under visual laryngoscope after anesthesia induction,twice in total.Group C was replaced with normal saline.The incidence and severity of extubation cough,hemodynamic changes,recovery quality and adverse reactions of two groups were recorded.Results The incidence of cough(80.0%)and moderate and severe cough(40.0%)in group C were significantly higher than those in group T(46.7%and 10.0%),the differences were statistically significant(P<0.05).The MAP[(108.4±18.0)mmHg,1 mmHg=0.133 kPa]and HR[(79.1±12.0)times/min]in group T were significantly lower than those in group C[(118.9±20.4)mmHg,(85.8±12.6)times/min]immediately after extubation,the differences were statistically significant(P<0.05).There were no significant differences in the recovery time of spontaneous breathing,eye opening time,extubation time,and postoperative agitation score between the two groups(P>0.05).There were no related adverse reactions in the two groups.Conclusions 1%tetracaine topical anesthesia can significantly reduce the incidence and severity of choking cough during the recovery period of general anesthesia,reduce hemodynamic fluctuations,and does not affect the quality of recovery from general anesthesia,does not increase the incidence of adverse reactions.