摘要：
目的 探讨盐酸达克罗宁胶浆含服复合利多卡因咽喉部喷雾在患儿食管扩张术中的麻醉效果.方法 选择拟在门诊行胃镜辅助下食管扩张术的先天性食管闭锁术后食管狭窄患儿 80例,男 5 1 例,女 2 9 例,年龄 6 个月至 3 岁,体重 5~1 2 kg,ASA Ⅰ或Ⅱ级.随机分为四组:单纯全麻组(A组)、全麻联合达克罗宁表麻组(B组)、全麻联合利多卡因表麻组(C组)、全麻联合达克罗宁复合利多卡因表麻组(D组),每组 20 例.入室前 10~15 min,B组和D组由麻醉医师指导家长予患儿1 %盐酸达克罗宁胶浆0.2~0.3 ml/kg分次含服.麻醉诱导后,C 组和 D组在喉镜暴露下以 2 %利多卡因0.15~0.2 ml/kg经喉麻管在咽喉部黏膜表面喷雾.观察并记录患儿术中 SpO2下降(SpO2<94%)、呛咳、体动反应的发生情况及术后苏醒时间和苏醒期躁动的发生情况.结果 D 组术中SpO2下降、呛咳发生率明显低于A组和B组,术中体动反应发生率明显低于,苏醒时间明显短于A、B和C组(P<0.05),苏醒期躁动发生率明显低于 A组和 C 组(P<0.05 ).结论 盐酸达克罗宁胶浆含服复合利多卡因咽喉部喷雾表面麻醉可有效降低全麻下食管扩张术中患儿SpO2下降、呛咳、体动反应发生率,缩短苏醒时间,减少苏醒期躁动.%Objective To study the anesthetic effect of oral dyclonine hydrochloride mucilage combined with laryngopharyngeal spray of lidocaine in infant esophagus dilatation.Methods Eighty infants with anastomotic stenosis after surgical correction of esophageal atresia under esophagus dila-tation assisted with gastroscope,51 males and 29 females,age 6 months to 3 years,weighing 5-12 kg,ASA physical status Ⅰ or Ⅱ,were randomly divided into four groups with 20 cases each:general anesthesia group (group A),general anesthesia combined with dyclonine surface anesthesia group (group B),general anesthesia combined with lidocaine surface anesthesia (group C),general anesthesia combined with dyclonine and lidocaine surface anesthesia group (group D).Infants in group B and group D were given 1 % dyclonine hydrochloride mucilage 0.2-0.3 ml/kg by their parents who were guided by the anesthesiologist at 10-15 min before entering the operating room,followed by slow intravenous injection of penehyclidine hydrochloride 0.01-0.02 mg/kg, propofol 2-2.5 mg/kg, remifentanil 1 μg/kg.After the induction,the children of group C and group D were exposed to 2% lidocaine 0.1 5-0.2 ml/kg through laryngoscope under laryngoscope to spray the laryngeal mucosa surface.All the children were converted to oxygen supply (6 L/min)asing double nasal high flow af-ter the mask was added to the stable breathing.Anesthesia was maintained by propofol 6 mg·kg-1·h-1,remifentanil 0.1 μg·kg-1·h-1infusion.In the case of somatic or choking during the operation,propofol and (or)remifentanil were inj ected into the pump to deepen the anesthesia. The occurrence of intraoperative oxygen saturation (SpO2<94%),cough and body reaction were ob-served and recorded,and the occurrence of postoperative recovery time and emergence agitation during recovery period were observed.Results The patients with oxygen saturation in group D de-creased,the incidence of cough was significantly lower than that of groups A and B (P<0.05 ), without significant difference in group C, body dynamic reaction rate was significantly lower compared with the other three groups (P<0.05),the recovery time was significantly shorter com-pared with the other three groups (P<0.05),the incidence of emergence agitation significantly de-creased (P<0.05).Conclusion Oral dyclonine hydrochloride mucilage combined with laryngopha-ryngeal spray of lidocaine can effectively decrease hypoxemia,cough,body movement,shorten recov-ery time,reduce emergence agitation in infants undergoing the esophageal dilatation.
