气道表面麻醉对术中全麻药物使用量的影响

Effect of Airway Surface Anesthesia on the Use of General Anesthesia during Operation

目的:研究气道表面麻醉对术中全麻药的用量和对患者术中血流动力学变化的影响。方法:选取2021年5月至2021年7月于我院行全麻下膝关节双间室置换术的患者60例。随机分为A、B两组,每组30人,A组插管前给予2%利多卡因5 ml喷喉,B组插管前给予生理盐水5 ml喷喉。推注舒芬太尼0.2 μg/kg、丙泊酚20 mg/kg、顺式阿曲库铵0.2 mg/kg至患者入睡。用喉麻管向声门上方推注药液后,插入气管导管。术中丙泊酚4~6 mg/(kg•h)静脉泵入、间断静注舒芬太尼0.2 μg/kg,维持患者脑电双频谱指数(BIS)值40~50,血压(BP)和HR的变化幅度 0.05)。两组的SBP、DBP、HR在气管插管后1 min (T4)、5 min (T5),拔管即刻(T6)统计学差异显著(P 【0.05)。2组舒芬太尼的用量有统计学差异(P 【0.05),丙泊酚的用量无统计学差异。结论:气道表面麻醉不仅能减少舒芬太尼的用药量,还能降低维持术中血流动力学稳定的难度,减少术中应激反应,体现了现代外科学加速术后康复的理念,具有一定的临床应用价值。

Objective: To study the effect of airway surface anesthesia on the amount of total anesthesia and hemodynamic changes during operation. Methods: This study involved 60 patients who underwent joint replacement surgery in The Affiliated Hospital of Qingdao University between May 2021 and July 2021. They were randomly divided into two groups, A and B, with 30 people in each group. Group A was given 2% lidocaine before intubation, and group B was given normal saline before in-tubation. Anesthesia was induced with propofol 20 mg/kg, sufentanil 0.2 μg/kg, Cis-atracurium 0.2 mg/kg. The laryngeal hemp tube is injected above the glottis at a uniform speed. After the liquid is fully infiltrated, the tracheal tube is inserted. During the operation, 4~6mg/(kg•h) of propofol was pumped intravenously and 0.2 μg/kg of sufentanil was intermittently injected intravenously. Bispectral index (BIS) value was maintained at 40~50, and the variation range of blood pressure (BP) and HR was less than 30% of the basic value. Blood pressure and heart rate were recorded be-fore induction of anesthesia (basal value, T1), after induction of anesthesia (T2), immediately after endotracheal catheter insertion (T3), 1 min after endotracheal intubation (T4), 5 min after endo-tracheal intubation (T5), 15 min after intubation (T6), and immediately after extubation (T7). Postoperative total anesthetic dosage and endotracheal intubation time were recorded, and pa-tients were followed up for intraoperative awareness, hoarseness, nausea and vomiting, urinary re-tention, intestinal obstruction and hyperalgesia. Results: During operation, SBP, DBP and HR of the 2 groups were similar before anesthesia induction (T1), after anesthesia induction (T2), and imme-diately after endotracheal catheter insertion (T3), but the differences were not statistically signifi-cant (P >0.05). SBP, DBP and HR of the two groups were significantly different in 1 min (T4) and 5 min (T5) after tracheal intubation, and immediately after extubation (T6) (P <0.05). The dosage of sufentanil in the two groups was statistically different (P <0.05), and there was no statistical dif-ference in the dosage of propofol. Conclusions: Airway surface anesthesia can not only reduce the dosage of sufentanil, but also reduce the difficulty of maintaining intraoperative hemodynamic sta-bility and reduce intraoperative stress response, which embodies the concept of modern surgery to accelerate postoperative rehabilitation and has certain clinical application value.