碳酸利多卡因联合丁卡因局部麻醉在鼻内镜手术中的应用

摘要

Objective To investigate the application value of local anesthesia with lidocaine carbonate and tetracaine in the prevention of tracheal intubation and extubation response in nasal endoscopy. Methods From January 2016 to March 2017, 90 patients scheduled for endoscopic sinus surgery were randomly divided into 3 groups,with 30 cases in each group.Before endotracheal intubation,1%tetracaine was used for endotracheal surface anesthesia,and air was filled into tracheal intubation airbag(group T). The intratracheal surface was sprayed with physiological saline and 1.73%lidocaine carbonate was filled into tracheal intubation airbag (group C).The 1%tetracaine was used for endotracheal surface anesthesia,and 1.73%lidocaine carbonate was filled into tracheal intubation airbag(group TC).The mean artery pressure(MAP)and heart race(HR)were recorded before induction(T1), immediately after intubation(T2),immediately after extubation(T3),and 5 min after extubation(T4).The scoring of cough during extubation was recorded.Sore throat scores were recorded by using Visual Analogue Scale(VAS)at 30 min,1 h,2 h,6 h and 24 h after extubation,respectively. Results The MAP and HR were less in the group T and TC than those in the group C at T 2(F=8.384,P=0.000;F=6.154,P=0.003), less in the group C and TC than in the group T at T 3(F=14.112, P=0.000; F=3.514,P=0.034).The cough scores were the lowest in the group TC(0.9 ±0.7), median in the group C(1.3 ±0.7), and the highest in the group T(1.7 ±0.5)(F=10.307, P=0.000).The VAS scores of pharyngalgia were the lowest in the group TC (2.1 ±0.8),median in the group C(3.0 ±1.2),and the highest in the group T(3.8 ±1.3)(F=17.961,P=0.000)at 30 min after surgery,and lower in the group TC(1.8 ±0.7)than in the group T(2.5 ±1.0)(F=5.058,P=0.008)at 1 h after surgery.Conclusion Local anesthesia combined with lidocaine carbonate and tetracaine can effectively reduce the cardiovascular response of endotracheal intubation and extubation and relieve the incidence of postoperative cough and sore throat.%目的 探讨碳酸利多卡因联合丁卡因局部麻醉在鼻内镜手术气管插管和拔管时的应用价值. 方法 选择2016年1月~2017年3月择期鼻内镜手术90例,随机分为3组,各30例:T组,气管插管前1%丁卡因气管内表面麻醉,插管后向气囊内缓慢注入空气;C组,插管前生理盐水气管内表面喷洒,插管后向气囊内缓慢注入1.73%碳酸利多卡因;TC组,插管前1%丁卡因气管内表面麻醉,插管后向气囊内缓慢注入1.73%碳酸利多卡因.记录诱导前(T1)、插管即刻(T2)、拔管即刻(T3)、拔管后5 min(T4)的平均动脉压(mean artery pressure,MAP)和心率(heart race,HR);记录拔管期呛咳评分;记录拔管后30 min、1 h、2 h、6 h和24 h咽痛视觉模拟评分(Visual Analogue Scale,VAS). 结果 MAP、HR T2时T组和TC组