2利多卡因压力雾化吸入用于清醒镇静气管插管的研究

摘要

目的 探讨2%利多卡因高氧流量压力雾化吸入对上呼吸道黏膜表面麻醉的效果.方法 选择拟在气管插管全身麻醉下行择期手术的患者20例,插管前静脉推注咪唑安定0.03 mg/kg,同时予丙泊酚2 mg/(kg·h)及瑞芬太尼0.05 μg/(kg·min)恒速泵注10 min,将患者OAA/S评分滴定至3～4分后在高氧流量(10 L/min)压力下将2%利多卡因雾化吸入进行表面麻醉,表面麻醉完成后予以气管插管.记录患者气管插管前后不同时间点的平均动脉压(MAP)、心率(HR)及脉搏氧饱和度(SpO2),同时进行插管条件评分,记录相关并发症的发生例数及术后24 h访视情况.结果 20例患者均一次插管成功,平均插管条件评分为(7.2±1.2)分.患者MAP、HR在插管后即刻较插管前升高(P ＜ 0.05),但MAP在插管后1 min,HR在插管后3 min即降低,与插管前比较差异无统计学意义.患者均未出现牙齿口腔软组织损伤、局麻药中毒及呼吸抑制,术后访视未诉咽喉疼痛、声嘶,对压力雾化表面麻醉和气管插管的过程均无记忆.结论 2%利多卡因高氧流量压力雾化吸入的上呼吸道黏膜表面麻醉效果满意.%Objective To evaluate the topical anesthesia effect with Lidocaine nebulized by 10 L/min oxygen flow rate during awake tracheal intubation. Methods 20 adult patients for elective surgery under general anesthesia, aged 18-60 years old, Mallampti I - II class, were observed. Before topical anesthesia the observer's assessment of alert and sedation (OAA/S) scale was controlled to 3-4 points by intravenous Midazolam (0.03 mg/kg), Propofol [2 mg/(kg-h)] and Remifentanil [0.05 (jug/ (kg-min)]. 10 minutes after sadation, topical anesthesia was performed with the nebulized 2% Lidocaine at 10 L/min oxygen flow rate, and patients were told to breathe deeply. Tracheal intubation was performed after topical anesthesia. The arterial pressure (MAP), heart rate (HR) and pulse oxygen saturation (SpO2) were recorded at nine points during intubation period. Intubation condition was assessed and the complications like local anesthetic toxicity, mucosa injury, respiration depress were also recorded. Patients were asked whether they could recall the events during intubation 24 h after operation. Results All patients were intubated at the first time, and average intubation condition score was (7.2±1.2) points. MAP, HR increased significantly immediately after the tracheal intubation (P < 0.05), and decreased soon after intubation. There were no corresponding complications occurred and patients have no recall about intubation procedure. Conclusion The topical anesthesia with 2% Lidocaine nebulized by 10 L/min oxygen flow rate is satisfactory for awake tracheal intubation.