静脉输注利多卡因与右美托咪定对腔镜甲状腺手术后拔管期呛咳反应的影响

摘要

目的 比较静脉输注利多卡因与右美托咪定对腔镜甲状腺手术后拔管期呛咳反应的影响.方法 择期行腔镜甲状腺手术的患者60例, ASAⅠ～Ⅱ级, 随机分为利多卡因组 (L组) 、右美托咪定组 (D组) 和对照组 (C组) , 每组20例.L组在麻醉诱导前10 min静脉注射利多卡因负荷量1.5 mg, 继以1.5 mg/ (kg·h) 的速度输注至术毕前30 min;D组在麻醉诱导前静脉输注右美托咪定负荷量1μg/kg, 时间为10 min, 继以0.4μg/ (kg·h) 的速度输注至术毕前30 min, 而C组则输注等容量的生理盐水.记录拔管期和咳嗽的发生率和程度;记录麻醉前 (T0) 、拔管后即刻 (T1) 和拔管后5 min (T2) 的MAP和HR;记录术后24 h的引流量.结果 与C组比较, L组和D组拔管期的呛咳发生率和程度明显降低 (P<0.05);与C组比较, T1和T2时L组和D组的MAP和HR上升不明显 (P<0.05);术后24 h引流量, L组和D组明显少于C组 (P<0.05) .结论 静脉输注利多卡因和右美托咪定均可以有效抑制腔镜甲状腺手术后拔管期的呛咳反应, 且两者之间无显著差异.%Objective Comparation of the effects of intravenous lidocaine and dexmedetomidine on coughing during extubation after endoscopic thyroidectomy. Methods 60 patients who underwent endoscopic thyroidectomy were randomly divided into group L, group D and group C, each group included 20 cases. Group L were given a loading lidocaine 1.5 mg/kg over 10 minutes before anesthesia induction, followed by a continuous intravenous lidocaine 1.5 mg/ (kg·h) until 30 min before the end of surgery. Group D were given a loading dexmedetomidine 0.5μg/kg over 10 minutes before anesthesia induction, followed by a continuous intravenous dexmedetomidine 0.4 μg/ (kg · h) until 30 min before the end of surgery. Group C were given intravenous infusion of equal volume normal saline. The incidence and severity of coughing were recorded within 2 minutes after extubation. Hemodynamic variables were measured at T0 (before anaesthesia induction) , T1 (immediately after extubation) , and T2 (5 min after extubation). The volume of drainage was recorded within 24 hours after surgery. Results The incidence and grade of cough were significantly lower in group L and group D than in group C (P < 0.05). Compared with group L and group D, MAP and HR were significantly increased in group C at T1 and T2 (P < 0.05). Compared with group C, the volume of drainage was significantly reduced in group L and group D within 24 hours after surgery (P < 0.05).Conclusion Intravenous lidocaine and dexmedetomidine can effectively inhibit coughing during extubation period after endoscopic thyroidectomy, and there is no significant difference between the two treatments.