达克罗宁抑制双腔气管导管插管及拔管期心血管反应的临床效果

摘要

目的：观察达克罗宁抑制双腔气管导管插管及拔管期心血管反应的临床效果。方法将60例择期全身麻醉开胸手术行双腔气管插管的患者按随机数字表法分为2组，每组30例。达克罗宁组（A 组）于插管前在双腔气管导管前20 cm 处均匀涂抹盐酸达克罗宁胶浆；石蜡油组（B 组）于插管前相同位置涂抹等量石蜡油。分别记录2组患者手术时间、气管插管保留时间、术中芬太尼用量、术中失血量、术中补液量，双腔气管插管前（T0）、插管即刻（T1），插管后3 min（T2）、5 min（T3），拔管前（T4）、拔管即刻（T5），拔管后3 min（T6）、5 min（T7）时的心率（HR）、动脉收缩压（SBP）、动脉舒张压（DBP）和血浆去甲肾上腺素（NE）水平变化，观察术后第3天患者咽喉部并发症（咽部疼痛、声音嘶哑）的发生情况。结果2组患者年龄、体质量、手术时间、气管插管保留时间、术中芬太尼用量、术中失血量及术中补液量比较差异均无统计学意义（均 P ＞0．05）。2组 T1时的 HR、SBP、DBP 及 NE 水平与 T0比较均显著升高（均 P ＜0．05）；A 组 T2—T7时各项指标与 T0比较差异无统计学意义（均 P ＞0．05）。B 组 T2—T7时的 HR、SBP、DBP 及 NE 与 T0及 A 组比较均显著升高（均 P ＜0．05）。A 组术后发生咽部疼痛8例、声音嘶哑3例；B 组发生咽部疼痛17例，声音嘶哑8例，B 组术后咽喉部并发症发生例数明显高于 A 组（P ＜0．05）。结论盐酸达克罗宁有利于维持双腔支气管导管插管和拔管时血流动力学稳定，并减少了术后呼吸道并发症的发生。%ABSTRACT:Objective To observe the inhibitory effect of dyclonine on cardiovascular response during double-lumen endotracheal intubation and extubation.Methods Sixty patients undergoing selective thoracotomy and double-lumen endotracheal intubation under general anesthesia were randomly divided into two groups,with 30 patients in each group.The equal amounts of dyclonine hydrochloride and paraffin oil were evenly painted at 20 cm on the double-lumen endobronchial tubes before intubation in group A and group B,respectively.The operation time,endotracheal in-tubation retention time,intraoperative fentanyl consumption,intraoperative blood loss and intrao-perative fluid infusion volume were recorded in both groups.Furthermore,heart rate (HR),sys-tolic blood pressure (SBP),diastolic blood pressure (DBP)and plasma norepinephrine (NE)lev-els were measured before intubation (T0 ),immediately after intubation (T1 ),3 minutes after in-tubation (T2 ),5 minutes after intubation (T3 ),before extubation (T4 ),immediately after extuba-tion (T5 ),3 minutes after extubation (T6 )and 5 minutes after extubation (T7 ).Moreover,throat complications (pharyngeal pain and hoarseness)were observed 3 days after operation.Results There were no significant differences in the age,body mass,operation time,intubation retention time,fentanyl consumption,intraoperative blood loss and intraoperative fluid infusion volume be-tween the two groups (P >0.05).Compared with T0 ,the HR,SBP,DBP and NE levels were in-creased at T1 in both groups (P <0.05).In group A,all the indexes were not changed at T2-T7 , compared with T0 (P >0.05).In group B,the HR,SBP,DBP and NE levels were increased at T2-T7 ,compared with T0 (P <0.05).Compared with group A,the HR,SBP,DBP and NE levels were increased in group B (P <0.05).In group A,8 patients had pharyngeal pain and 3 patients had hoarseness.In group B,17 patients had pharyngeal pain and 8 patients had hoarseness.Compared with group A,the incidence of throat complications significantly increased in group B (P <0.05). Conclusion Dyclonine hydrochloride can maintain hemodynamic stability during double-lumen endotracheal intubation and extubation,and reduce the incidence of postoperative respiratory com-plications.