注药型气管导管表面麻醉抑制气管插管心血管反应临床研究

目的 观察"声门上下注药型气管导管"(专利号:ZL 200820111377.4)在全身麻醉气管插管后立刻注射表面麻醉药能否减轻气管插管的心血管反应.方法 择期骨科手术患者40例,ASA分级Ⅰ、Ⅱ级,年龄20~60岁,BMI 22~30 kg/m2,按随机数字表法分为试验组和对照组,每组20例.以咪达唑仑0.04 mg/kg、舒芬太尼0.2μg/kg、依托咪酯0.25 mg/kg和维库溴铵0.1 mg/kg麻醉诱导,手控呼吸3 min后30 s内完成经口插入声门上下注药型气管导管,试验组立即注射1%丁卡因1.5 ml(声门下即气管内1 ml,声门上即咽喉部0.5 ml)施表面麻醉,对照组不注射药.固定导管,接麻醉机通气.分别于入室安静时(基础值,T0)、插管前即刻(T1)、插管后即刻(T2)、插管后1 min(T3)、插管后3 min(T4)和插管后5 min(T5)记录BP、HR和抽取血液标本测定血浆肾上腺素(epinephrine,E)、去甲肾上腺素(noradrenaline,NE)、皮质醇(cortisol,Cor)水平.结果 试验组SBP仅在T2时较T0时显著升高17%(P<0.05),对照组SBP在T2、T3、T4时分别较T0时显著升高29%(P<0.01)、36%(P<0.01)、15%(P<0.05);在T2~T5时,试验组SBP比对照组明显降低(P<0.05).试验组HR插管后没有显著升高(P>0.05),而对照组HR在T2、T3时分别显著升高18%(P<0.01)和14%(P<0.05),组间比较差异有统计学意义(P<0.05).试验组血浆E水平在T3和T5时明显较对照组低(P<0.05),血浆NE水平在T3和T5时试验组明显较对照组低(P<0.05).试验组血浆Cor水平在T5时明显较对照组低(P<0.01).结论 使用注药型气管导管在插入时立即注射表面麻醉药实施气管内、咽喉表面麻醉,能明显降低气管插管引起的心血管反应.

Topical anesthesia through tracheal tubing inhibited cardiovascular responses to tracheal intubation

Objective To investigate whether topical anesthesia of endotracheal and laryngopharynx through tracheal tubing inhibits cardiovascular responses to tracheal intubation. Methods Forty ASA grade Ⅰand Ⅱ patients (20-60 y) subjected to elective orthopedic surgery were assigned into test and control group (n=20). After anesthesia with midazolam, sufentanil, etomidate and vecuronium, manual ventilation was performed for 3 min. Then, a triplet tracheal tube was inserted from mouth into endotracheal within 30 s, and 1% tetracaine was quickly delivered into endotracheal and laryngopharynx through two tubes attached on the ventilation tube of the triplet tube. The tube was retained for mechanical ventilation throughout the operation. SBP, DBP, HR, epinephrine(E), noradrenaline(NE) and cortiso(Cor) were measured when patients entered into surgery room (T0), just before (T1) and after (T2) endotracheal, and 1 (T3), 3 (T4) min, and 5 (T5) min after intubation. Results Compared with levels at T0, SBPs were significantly increased (17%) only at T2 in test group (P<0.05), while were significantly increased by 29%(P<0.01), 36%(P<0.01) and 15%(P<0.05) at T2,T3 and T4, respectively, in control group. SBPs were significantly lower in test group than in control group at T2through T5. Compare with the levels at T0, HRs were not significantly changed in test group (P>0.05), but were significant increased by 18% (P<0.01) and 14% (P<0.05) at T2 and T3, respectively, in control group. Levels of serum E and NE in test group were significantly lower than those of control group at T3 and T5(P<0.05), and levels of serum Cor in test group were significantly lower than those of control group at T5 (P<0.01). Conclusions Endotracheal and laryngopharynx topical anesthesia with tetracaine through modified tracheal tube markedly inhibited cardiovascular responses following endotracheal intubation.