喉罩全麻复合气道喷洒利多卡因在支气管介入手术麻醉中的应用

Application of laryngeal mask general anesthesia combined with Lidocaine airway spray in the anesthesia of bronchial intervention

目的探讨喉罩全麻复合气道喷洒利多卡因在支气管介入手术麻醉中的应用。方法选取武汉中心医院2014年6月~2016年1月收治的择期行纤支镜介入手术麻醉分级(ASA)Ⅰ~Ⅲ级的患者54例,采用随机数字表法分成喉罩全麻复合利多卡因组(观察组)和单纯喉罩全麻组(对照组),每组27例。观察组通过全麻诱导置入喉罩再通过纤支镜直视下行会厌声门及支气管内喷洒2%利多卡因6~10 m L,1 min喷洒后行纤支镜介入手术;对照组直接全麻诱导置入喉罩,然后行纤支镜介入手术。记录入室时的基础值(T0)、麻醉诱导插入喉罩后(T1)、手术开始后5 min(T2)、手术操作20 min(T3)及手术结束时(T4)、患者苏醒喉罩拔出时(T5)的平均动脉压(MAP)、心率(HR)、气道压、麻醉药用药量以及患者苏醒时间;并于T0~T5时点采集动脉血样3 m L,测定血浆肾上腺素和去甲肾上腺素水平,观察两组患者的应激反应。结果两组T0、T1时点的MAP、HR、Sp O2水平比较差异无统计学意义(P>0.05);观察组T2、T3、T4、T5时点的MAP水平明显低于对照组,HR明显慢于对照组(P<0.05),Sp O2水平明显高于对照组(P<0.05)。两组MAP和HR均呈现先降低后升高的趋势,而Sp O2水平呈现先升高再降低的趋势。两组肾上腺素和去甲肾上腺素水平均呈现先升高后降低趋势,观察组T2、T3、T4、T5时点上述指标水平显著低于对照组(P<0.05);观察组麻醉苏醒时间较对照组显著缩短(P<0.05),且麻醉药物用量明显少于对照组(P<0.05)。结论与单纯喉罩全麻比较,纤支镜支气管介入术喉罩全麻复合气道直视下喷洒利多卡因可提供更为平稳的血流动力学,减少麻醉药的用量和患者的应激反应。

Objective To explore application of laryngeal mask general anesthesia combined with Lidocaine airway spray in the anesthesia of bronchial intervention. Methods 54 selective endoscopic intervention operation patients with anesthesiologists(ASA) Ⅰ- Ⅲ in Wuhan Central Hospital from June 2014 to January 2016 were selected. All patients were divided into laryngeal mask general anesthesia combined with Lidocaine group(observation group) and simple laryngeal mask anesthesia group(control group) by using the random number table method. Each group of 27 cases. Observation group through the induction of general anesthesia in laryngeal mask by bronchoscopy look downward epiglottis glottis and endobronchial sprayed with 2% Lidocaine 6-10 m L, sprayed 1 min after bronchoscopy interventional surgery; general anesthesia induction in laryngeal mask were used directly in control group, then bronchoscopy mirror interventional surgery was applied. Mean arterial pressure(MAP), heart rate(HR), patients with airway pressure when the basis of the value(T0), after anesthesia induction inserting laryngeal mask(T_1), surgery after the first 5 min(T_2) and20 min of operation(T_3) and at the end of surgery(T_4), patients with laryngeal mask(T_5), anesthetics dose and awakening time were recorded. And artery blood sample 3 m L in T_0- T_5 point were collected. The levels of plasma concentration of epinephrine and norepinephrine were detected, stress reaction in two groups o f patients were observed. Results The differences of MAP, HR and Sp O_2 at T_0,T_1 between two groups were not statistically significant(P > 0.05).The levels of MAP in observation group at T_2,T_3,T_4,T_5 were obviously lower than those in control group, HR at T_2,T_3,T_4,T_5 were obviously slower than those in control group(P < 0.05),while the Sp O_2 levels at differenttime levels were significantly higher than those in control group(P < 0.05). MAP and HR in two graups were decreased at first and then increased at a decreasing trend, SpO_2level showed a trend of first increasing and then decreasing. The epinephrine and norepinephrine in two groups showed a trend of decreasing first and then increasing, which in observation group at T_2,T_3,T_4,T_5 were significantly lower than those in control group(P < 0.05). The waking-up time in observation group was significantly shorter than that in control group(P < 0.05), and the usage of narcotic drugs were obviously less than those in control group(P < 0.05). Conclusion Compared with the pure laryngeal mask anesthesia,bronchial bronchoscopy in the laryngeal mask anesthesia compound airway under direct spraying Lidocaine can provide a more stable hemodynamics,decrease the dosage of the drug and the patient's stress response.