【作者】 刘爽；

【导师】 李龙云；

【作者基本信息】 吉林大学 ， 麻醉学（专业学位）， 2021， 硕士

【摘要】 目的:本实验在拔管前5分钟通过不同方式给予利多卡因,观察利多卡因对于全麻患者苏醒期时由于拔管前后的气道应激反应引起的血流动力学变化以及呛咳程度等情况。方法:选择本院ASA分级I-II级、年龄40-70岁之间、行择期全麻手术患者60例作为研究对象。患者入手术室后,行常规麻醉诱导,插管成功后进行机械通气,术中采用丙泊酚复合瑞芬太尼泵注进行麻醉维持,手术结束前30min不再给予肌松药,手术结束后苏醒拔管期不给予新斯的明进行肌松拮抗,拔管前5min分别通过不同方式给予利多卡因,后进行口腔内吸痰,待患者苏醒完全后行气道内吸痰及拔管。应用随机分组法将研究患者分为三组:A组(n=20):拔管前5min静脉注射利多卡因1.0mg/kg;B组(n=20):拔管前5min进行利多卡因气道表面麻醉1.0mg/kg;C组(n=20):不给予任何处理。分别记录三组患者入室后(T1)、拔管前5分钟(T2)、拔管时(T3)、拔管后5min(T4)时的心率、血压、平均动脉压,对比三组患者拔管前吸痰及拔管时的呛咳程度,术后镇静评分以及拔管时是否有不良事件发生,例如躁动、喉痉挛等。结果:三组间基础资料年龄、身高、体重、BMI比较,差异没有统计学意义(P>0.05)。三组间进行比较,T3、T4时刻A组、B组的平均动脉压、心率均低于C组,且B组低于A组;观察吸痰拔管时呛咳程度:A组、B组呛咳程度均轻于C组,且B组好于A组;术后镇静评评分A组高于B组、C组;术后不良事件发生率差异无统计学意义(P>0.05),术后A组、B组均未发生不良事件,C组有两例患者出现不良事件。结论:吸痰拔管前5min通过静脉或进行气道表面麻醉给予1.0mg/kg利多卡因均可有效控制吸痰拔管时对咽喉气管的刺激,维持血流动力学的稳定,且吸痰拔管前进行气道表面麻醉的效果更优。更多还原

【Abstract】 Objective:In this study,lidocaine was administered in different ways 5 minutes before extubation to observe the hemodynamic changes and the degree of cough caused by airway stress response before and after extubation during the recovery period of patients under general anesthesiaMethods:The ASA grade I-II,age 40-70 years,60 patients undergoing elective general anesthesia were selected as the subjects.After the patient enters the operating room,Routine anesthesia induction,Mechanical ventilation after successful intubation,Intraoperative use of propofol combined with remifentanil pump for anesthesia maintenance,And no muscle relaxants30 min before surgery,No muscle relaxation antagonism was performed on neostigmine during extubation,Five min before extubation were given lidocaine in different ways,After the oral suction sputum,After the patient wakes up completely,suction sputum and extubation in the airway.The patients were divided into three groups by randomized grouping: A group(n=20): intravenous lidocaine 1.0 mg/kg;5 min before extubation B group(n=20): lidocaine airway surface anesthesia 1.0 mg/kg;5 min before extubation C group(n=20): no treatment.The heart rate,blood pressure and mean arterial pressure of three groups were recorded after entering(T1),5 minutes before extubation(T2),5 min after extubation(T4),Comparison of sputum aspiration before extubation and cough during extubation in three groups,Postoperative sedation scores and extubation,such as restlessness,laryngeal spasm,etc.Results:There was no statistical difference in age,height,weight and BMI among the three groups(P > 0.05).At T3 and T4,the mean arterial pressure and heart rate of group A and group B were lower than that of group C,and group B was lower than that of group A.The cough degree of sputum suction and tube pulling was observed.The cough degree of group A and group B was lighter than that of group C,and group B was better than group A.The score of postoperative sedation in group A was higher than that in group B and C.There was no statistically significant difference in the incidence of postoperative adverse events(P>0.05).No adverse events occurred in Group A and Group B,and two patients in Group C had adverse events.Conclusion:The stimulation to the laryngopharynx and trachea during sputum aspiration and tube withdrawal can be effectively controlled by intravenous or airway surface anesthesia with 1.0mg/kg lidocaine 5min before sputum aspiration and tube withdrawal,and the hemodynamic stability can be maintained.Moreover,airway surface anesthesia before sputum aspiration and tube extubation has better effect.更多还原