Efficacy of compound lidocaine cream combined with dyclonine solution in improving adverse reactions of endotracheal intubation
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摘要:目的
探讨复方利多卡因乳膏联合合适剂量达克罗宁胶浆改善气管插管不良反应的效果。
方法选取272例腹腔镜下胆囊切除患者, 随机分为4组, 每组68例。A组采用生理盐水润滑气管导管表面; B组、C组、D组分别应用复方利多卡因乳膏1、3、5 g涂抹于气管导管套囊及前端10 cm处。各组患者均术前口腔含服5 mL达克罗宁胶浆5 min。记录麻醉诱导前(T0)、插管后(T1)、手术开始(T2)、苏醒后(T3)、拔管后5 min (T4)的心率(HR)、平均动脉压(MAP); 记录麻醉时间、手术时间、苏醒时间、苏醒后带管时间; 记录拔管时呛咳、躁动发生率, 评估术后6、24 h的咽痛、声嘶、咳嗽评分。
结果4组各时点HR、MAP差异无统计学意义(P>0.05)。4组麻醉时间、手术时间、苏醒时间、苏醒后带管时间比较, 差异均无统计学意义(P>0.05)。拔管时C组呛咳率最低, 与A组、B组比较差异有统计学意义(P < 0.05);C组、D组躁动率与A组、B组比较, 差异有统计学意义(P < 0.05)。A组与B组术后并发症比较, 差异无统计学意义(P>0.05);C组、D组咽痛、声嘶发生率低于A组, D组较C组咳嗽发生率升高, 差异有统计学意义(P < 0.05)。
结论复方利多卡因乳膏联合达克罗宁胶浆能够有效减轻声门损伤和气管应激反应, 减小喉镜暴露和气管导管置入引发的应激性刺激。
Abstract:ObjectiveTo explore the efficacy of compound lidocaine cream combined with appropriate dose of dyclonine solution in improving adverse reactions of endotracheal intubation.
MethodsA total of 272 patients with laparoscopic cholecystectomy were selected and randomly divided into 4 groups, with 68 cases in each group.Group A used normal saline to lubricate the surface of endotracheal tube; groups B, C and D used 1, 3 and 5 g compound lidocaine cream to daubon cuff and 10 cm in front of endotracheal tube respectively.Patients in each group took 5 mL dyclonine solution orally for 5 minutes before operation.Heart rate (HR) and mean arterial pressure (MAP) at the time points of before anesthesia induction (T0), after intubation (T1), at beginning of operation (T2), after awakening (T3) and 5 minutes after extubation (T4) were recorded; the anesthesia time, operation time, awakening time and tube carrying time after awakening were recorded; the incidence rates of choking cough and agitation at extubation were recorded, and the scores of sore throat, hoarseness and cough at 6 and 24 hours after operation were evaluated.
ResultsThere were no significant differences in HR and MAP at each time point among the four groups (P>0.05).There were no significant differences in anesthesia time, operation time, awakening time and tube carrying time after awakening among the four groups (P>0.05).There was a significant difference in incidence of choking at extubation between group C (the lowest) and groups A, B (P < 0.05);there was a significant difference in agitation rate in groups C and D compared with groups A and B (P < 0.05).There was no significant difference in postoperative complications between group A and B (P>0.05);the incidence rates of pharyngeal pain and hoarseness in group C and D were lower than that in group A, and the incidence of cough in group D was significantly higher than that in group C (P < 0.05).
ConclusionCompound lidocaine cream combined with dyclonine solution can effectively alleviate glottic injury and tracheal stress response, and reduce laryngoscope exposure andstress stimulation due to endotracheal tube implantation.
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表 1 4组患者麻醉情况比较(x±s)
min 组别 n 麻醉时间 手术时间 苏醒时间 带管时间 A组 68 111.0±40.0 81.0±36.0 8.3±3.2 5.0±2.6 B组 68 107.0±38.0 77.0±35.0 7.9±3.5 5.4±3.8 C组 68 115.0±43.0 78.0±30.0 7.8±4.0 4.8±3.2 D组 68 109.0±42.0 85.0±41.0 8.1±3.8 5.1±3.0 
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表 2 4组患者不同时点HR和MAP比较(x±s)
指标 组别 n T0 T1 T2 T3 T4 HR/(次/min) A组 68 80.3±5.4 72.3±3.6 58.1±3.2 89.3±5.3 78.5±4.6 B组 68 83.2±5.0 74.6±4.0 60.2±2.8 91.0±5.4 80.4±4.2 C组 68 81.4±6.1 73.2±4.1 61.3±2.0 88.7±4.5 77.4±5.1 D组 68 82.5±4.8 75.1±3.8 59.8±2.4 90.3±5.1 79.1±4.6 MAP/mmHg A组 68 108.3±16.2 92.3±12.5 89.6±11.7 95.4±13.8 93.5±12.7 B组 68 110.1±14.8 90.4±13.1 91.5±12.8 96.4±12.6 96.5±11.6 C组 68 113.4±15.1 93.1±12.8 90.4±13.1 97.3±13.0 94.3±11.0 D组 68 109.2±15.5 91.6±13.0 88.9±12.5 96.8±11.8 95.3±12.4 T0: 麻醉诱导前; T1: 插管后即刻; T2: 手术开始; T3: 手术结束苏醒后; T4: 拔管后5 min; HR: 心率; MAP: 平均动脉压。
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表 3 4组患者术后躁动、呛咳及咽部并发症发生率比较[n(%)]
指标 时点 A组(n=68) B组(n=68) C组(n=68) D组(n=68) 呛咳 — 24(35.3)* 20(29.4)* 10(14.7) 16(23.5) 躁动 — 16(23.5) 10(14.7) 6(8.8)# 6(8.8)# 咽痛 术后6 h 30(44.1) 24(35.3) 14(20.6)# 12(17.6)# 术后24 h 26(38.2) 18(26.5) 10(14.7)# 8(11.8)# 声嘶 术后6 h 22(32.4)* 18(26.5)* 8(11.8) 8(11.8) 术后24 h 20(29.4)* 12(17.6)* 6(8.8) 6(8.8) 咳嗽 术后6 h 4(5.9)* 3(4.4) 0 7(10.3)* 术后24 h 4(5.9)* 2(5.9) 0 5(7.4)* 与C组比较, * P < 0.05; 与A组比较, #P < 0.05。
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