摘要
目的观察利多卡因气雾剂对全身麻醉声带息肉摘除术交感和迷走反应的抑制的影响。方法择期行声带息肉摘除术的全身麻醉者100例,ASA I～II级,随机分为利多卡因气雾剂组(L组) 50例和生理盐水对照组(C组) 50例。麻醉诱导后,L患者暴露声门后,对会厌和声门处喷利多卡因气雾剂,B组喷生理盐水。记录支撑喉镜置入时心动过缓的例数;记录麻醉诱导前(T_0)、插管前即刻(T_1)、插管后1 min(T_2)、手术开始即刻(T_3)、手术开始2 min(T_4)时患者的收缩压(SBP)、心率(HR)的数值以及术后呛咳的等级。结果 L组心动过缓的发生率明显低于C组(P <0. 05);全身麻醉诱导后2组患者T_1时HR、SBP均明显低于T_0时(P <0. 05); L组患者在T_2～T_4时HR、SBP均明显低于C组(P <0. 05); L组患者术后0级和1级呛咳的发生率明显低于C组(P <0. 05),差异有统计学意义。结论利多卡因气雾剂充分的表面麻醉能明显降低支撑喉镜所致心动过缓的发生率,降低患者插管和手术时的心血管交感反应,降低术后拔管时呛咳的程度。
Objective To observe the effect of lidocaine aerosol spraying on the inhibition of sympathetic and vagal reactions in the anesthesia of vocal cord polyp excision. Methods One hundred patients （ ASA Ⅰ - Ⅱ ） scheduled for vocal cord polyp excision were randomly divided into the lidocaine aerosol group （ or L group） and the normal saline control group, each consisting of 50 patients. After induction of anesthesia and exposure of glottis, lidocaine aerosol was sprayed at the epiglottis and glottis in the patients of the L group, while the patients of the control group were just given normal physiological saline. Cases of bradycardia （HR 〈 60 time/min） were recorded after laryngoscopy. Systolic blood pressure （SBP）, heart rate （HR） and grade of choking were monitored and recorded at the time points of pre-induction （ T0）, immediately before intubation （ T1 ）, 1 rain after intubation （ T2 ）, the moment after surgery （ T3 ）, and 2 minutes after surgery （T4）. Results The rate of bradycardia in the L group was obviously lower than that in the control group （ P 〈 0.05 ）. After induction of general anesthesia, the values of HR and SBP at T1 were significantly lower than that at TO （ P 〈 0.05 ）. The values of HR and SBP at T2 - T4 in the patients of the L group were all significantly lower than those in the patients of the control group（P 〈0.05 ）. After surgery, the rates of grade 0 and grade 1 choking in the patients of the L group were markedly lower than those of the control group, with statistical significance （P 〈 0.05 ）. Conclusion Full surface anesthesia with lidocaine aerosol spraying could effectively decrease the rate of bradycardia induced by laryngoscopy, suppress sympathetic reactions caused by tube intubation and vocal cord polyp excision and reduce the degree of choking during extraction of the tube after laryngoscopy.
作者
宗晓倩
马钰
王辰
李永华
Zong Xiaoqian;Ma Yu;Wang Chen;Li Yonghua(Department of Pharmacology,Shanghai Changzheng Hospital,CPLA,Shanghai 200003,China)
出处
《海军医学杂志》
2018年第5期431-433,共3页
Journal of Navy Medicine
基金
国家自然科学基金(81671304)
关键词
利多卡因气雾剂
心血管反应
迷走反应
交感反应
呛咳
Lidocaine aerosol
Cardiovascular response
Vagal reaction
Sympathetic reaction
Choking
