摘要
目的 观察利多卡因雾化吸入表面麻醉联合达克罗宁胶浆涂抹气管插管下端用于鼻内镜下鼻窦手术患者的临床效果。方法 选择2018年12月-2020年11月于秦皇岛市第一医院行鼻内镜手术的患者100例,按随机数字表法分为2组,每组各50例。2组患者均采用小剂量咪唑安定、芬太尼、右美托咪啶镇静镇痛(MAC)下完成经纤支镜引导经口气管插管。A组采用利多卡因雾化吸入联合达克罗宁胶浆涂抹气管插管下端,B组采用利多卡因喷喉联合环甲膜穿刺。分别于患者入室后1分钟(T_(0)),插管即刻(T_(1)),插管后5min(T_(2)),拔管即刻(T_(3)),拔管后5 min(T_(4))记录平均动脉压(MAP)、脉搏氧饱和度(SPO_(2))、心率(HR)。记录插管时间,记录插管期间是否发生呛咳、喉痉挛,术后2 h随访患者有无声音嘶哑、咽喉疼痛及有无术中知晓发生。记录并整理数据,对研究结果进行统计学分析,比较2组的麻醉效果。结果 与B组比较,A组MAP、HR于T_(3)、T_(4)时明显降低,差异有统计学意义(T_(3)时:t/P=8.403/<0.001、19.981/<0.001;T_(4)时:10.668/<0.001、17.678/<0.001);A组SPO_(2)在T_(1)时明显高于B组,差异有统计学意义(t/P=40.018/<0.001)。A组患者插管期间发生呛咳、喉痉挛的比例明显低于B组,差异有统计学意义(χ^(2)/P=5.263/0.022、6.383/0.012);拔管期间躁动评分及术后VAS明显低于B组,差异有统计学意义(t/P=41.110/<0.001、14.709/<0.001)。结论 MAC下利多卡因雾化吸入法表麻联合达克罗宁胶浆涂抹气管插管下端,对患者无创伤,插管期间氧供充分,围术期血流动力学更稳定,镇痛更完善,患者感觉舒适,整体满意度更高。
Objective To observe the clinical effect of aerosol inhalation of lidocaine combined with topical anesthesia and dacronin glue applied to the lower end of endotracheal intubation in patients undergoing endoscopic sinus surgery.Methods One hundred patients who underwent endoscopic sinus surgery in Qinhuangdao First Hospital from December 2018 to November 2020 were randomly divided into two groups with 50 cases in each group. Both patients were treated with low-dose midazolam, fentanyl and dexmedetomidine sedation and analgesia(MAC) to complete transoral endotracheal intubation guided by fiberoptic bronchoscope. Group A was treated with lidocaine atomization inhalation combined with dacronin glue to smear the lower end of endotracheal intubation, and group B was treated with lidocaine laryngeal spray combined with cricothyroid membrane puncture. The intubation was immediately(T_(1)) 1 minute after the patient entered the room(T_(0)), 5 min after intubation(T_(2)), immediately after extubation(T_(3)), and 5 min after extubation(T_(4)), record the mean arterial pressure(MAP), pulse oxygen saturation(SpO_(2)) and heart rate(HR). Record the intubation time, record whether there was choking cough and laryngeal spasm during intubation, and follow up the patients for hoarseness, throat pain and intraoperative awareness 2 hours after operation. Record and sort out the data, statistically analyze the research results, and compare the anesthetic effects of the two groups.Results Compared with group B, MAP and HR in group A were significantly lower than those in group B at T_(3) and T_(4), and the difference was statistically significant(T_(3):t/P=8.403/<0.001,19.981/<0.001;T_(4):10.668/<0.001,17.678/<0.001).The SpO_(2) in group A was significantly higher than that in group B at T_(1)(t/P=40.018/<0.001). The proportion of choking cough and laryngeal spasm in group A was significantly lower than that in group B(χ^(2)/P=5.263/0.022,6.383/0.012);the restlessness score and postoperative vas during extubation were significantly lower than those in group B(t/P=41.110/<0.001,14.709/<0.001).Conclusion Both groups of surface anesthesia can be used for endotracheal intubation guided by fiberoptic bronchoscope under Mac, and the anesthetic effect of group A is better than that of group B. Under Mac, lidocaine atomization inhalation combined with dacronin glue is applied to the lower end of endotracheal intubation, which has no trauma to patients, sufficient oxygen supply during intubation, more stable perioperative hemodynamics, more perfect analgesia, comfortable feeling and higher overall satisfaction.
作者
吴振宇
戚小航
张建刚
王现雷
杨晓春
张丽伟
Wu Zhenyu;Qi Xiaohang;Zhang Jiangang;Wang Xianlei;Yang Xiaochun;Zhang Liwei(Department of Anesthesiology,the First Hospital of Qinhuangdao City,Hebei Province,Qinhuangdao 066000,China)
出处
《疑难病杂志》
CAS
2022年第12期1293-1297,共5页
Chinese Journal of Difficult and Complicated Cases
基金
秦皇岛市科技计划资助项目(202101A045)。
关键词
利多卡因
雾化吸入
气管插管
盐酸达克罗宁胶浆
监测下麻醉管理技术
Lidocaine
Atomization inhalation
Endotracheal intubation
Dacronin hydrochloride slurry
Anesthesia management technology under monitoring
