经连表麻型气管行气管内表面麻醉在老年手术患者中的应用

Application of Intratracheal Superficial Anesthesia Using Continuously Topical Superficial Tracheal Tube in Operation for Elderly Patients

目的探讨分析经连表麻型气管行气管内表面麻醉在老年手术患者中的应用。方法整群选取该院2014年1月—2015年1月收治的86例老年手术患者,将其分为观察组(43例)和对照组(43例),给予观察组患者经连表麻型气管导管注入3m L盐酸利多卡因,给予对照组患者经普通气管导管口注入3 m L盐酸利多卡因,分别对两组患者行喉、气管内表面麻醉。观察两组患者拔管前后MAP、HR变化、Ramsay镇静评分和用药前后呛咳评分比较。结果观察组拔管时、拔管后30 min及拔管后1 h的HR、MAP和术前相比差异无统计学意义(P>0.05),对照组的MAP和术前相比有明显增高(P<0.01),拔管时、拔管后30 min及拔管后的HR和术前相比均有所增快(P<0.01)。两组患者在给予麻醉药物后其镇静评分均逐渐降低,观察组拔管前、拔管后的呛咳评分均低于对照组(P<0.05)。结论经连表麻型气管行气管内表面麻醉能有效抑制老年患者围拔管期由拔管操作导致的呛咳、心脑血管应激反应,值得推广和应用。

Objective To discuss the application value of intratracheal superficial anesthesia using continuously topical superficial tracheal tube in operation for elderly patients. Methods 86 elderly patients who needed surgical treatment and admitted to our hospital between January 2014 and January 2015 were divided into observation group(n=43) and control group(n=43). Patients in the observation group were given injection of 3 m L lidocaine hydrochloride using continuously topical superficial tracheal tube,while those in the control group were given injection of 3 m L lidocaine hydrochloride using normal trachea tube. Laryngeal anesthesia and intratracheal superficial anesthesia were performed in the two groups respectively. We compared the changes of MAP,HR before and after extubation, Ramsay sedation score and choking score before and after medication. Results No changes of MAP, HR were observed at extubation, 30 min after extubation and 1 h after extubation in the observation group,P>0.05. The MAP was higher after than before operation in the control group, P<0.01, and the HR at extubation, 30 min after extubation and 1 h after extubation were all higher than before operation in this group, P<0.01. The Ramsay sedation score after medication were lower than before in all the patients, and the choking score before and after extubation were all lower in the observation group than in the control group,P <0.05. Conclusion Intratracheal superficial anesthesia using continuously topical superficial tracheal tube can effectively inhibit choking and cardiovascular stress response caused by extubation in peri-extubation period.