利多卡因雾化吸入用于纤维支气镜引导清醒气管插管患者的效果观察

摘要

目的 观察超声雾化吸入2%利多卡因气道表面麻醉用于经鼻纤维支气管镜(FOB)辅助清醒气管插管的临床效果.方法 择期颈椎手术患者42例,随机均分为两组,分别采用超声雾化吸人2%利多卡因行呼吸道表面麻醉(Ⅰ组)和1%丁卡因鼻拭子鼻腔表面麻醉,环甲膜穿刺及喉上神经阻滞的联合局部麻醉(Ⅱ组).记录插管的时间(FNIT),入室后5 min(基础值,T1)、气管导管过鼻腔(T2)、FOB过咽喉(T3)、FOB过声门进气管确认气管隆突位置(T4)、气管导管进入气管(T5)时患者的反应及血流动力学的变化;记录Ⅰ组患者局部麻醉药物的用量及两组患者局部麻醉药的不良反应;术后第1天随访患者对两种方法的评价.结果 与T1时比较,T2～T5时两组患者HR增快;T2～T5时Ⅰ组及T2、T3时Ⅱ组患者MAP均增高;T2～T4时Ⅱ组SPO2明显降低(P<0.05).Ⅰ组患者利多卡因的平均用量为4.86 mg/kg,最大用量为7.64 mg/kg.Ⅰ组患者对所接受的局部麻醉方法评价为((6.71±1.23)分,明显高于Ⅱ组(4.90±1.41)分(P<0.05).结论 超声雾化吸入2%利多卡因可为经鼻FOB清醒插管提供充分的表面麻醉,易于被患者所接受,值得在临床工作中推广.%Objective To evaluate the effects of ultrasonic nebulization with 2％ lidocaine for topical anesthesia in awake fiberoptic nasotracheal intubation.Methods Forty-two patients undergoing elective cervical operation were equally randomized into two groups: group I and group Ⅱ.In group I , nebulized 2％ lidocaine with ultrasonic nebulizer was used for topical anesthesia; In group Ⅱ , superior laryngeal nerves were blocked and cricothyroid membrane injection was adopted after being applied cotton swab-stick with 1％ tetrocaine to the selected nostril.The fiberopitic nasotracheal intubation time (FNIT) was recorded, and the reactions and the hemodynamic responses to the procedures in both two groups at times of before intubation (T1), catheter entering nasal cavity (T2), FOB passing through throat (T3), FOB achieving trachea eminence (T4) and intubating trachea catheter (T5) were evaluated.The dose of local agents of each patient was recorded in group I.The side effects of local agents in both groups were also observed.The patient satisfaction on topical anesthetic procedures over the operation day was evaluated.Results Compared to T1, the HR at T2-T5 increased in both groups (P＜0.05); and the MAP in group I at T2, T3, in group Ⅱ at T2-T5, were higher than those at T1 respectively (P＜0.05).At T2-T4, the SpO2 was lower in group Ⅱ than that of group I (P＜0.05).The average dose of lidocaine was 4.86 mg/kg, and the maximum dose was 7.64 mg/kg.The grade of the satisfaction to the topical anesthetic procedures in group I was 6.7 ± 1.2, higher than that of group Ⅱ (4.9 ±1.4) (P ＜ 0.05).Conclusion Ultrasonic nebulization with 2％ lidocaine can provide enough topical anesthesia for awake fibroptic nasotracheal intubation.This method was acceptable to the patients and could be used in routine practice.