喷雾气管导管减轻冠心病患者全麻拔管期心血管反应的临床观察

目的观察喷雾气管导管在冠心病患者全麻拔管期对血流动力学的影响及围拔管期不良反应的发生情况。方法将60例择期行全麻气管插管手术的冠心病患者,分为喷雾气管导管利多卡因表面麻醉组(SL组)、喷雾气管导管组(S组)和普通气管导管组(C组)。记录诱导前(T0)、拔管前(T1)、拔管即刻(T2)及拔管后1 min(T3)、拔管后2 min(T4)、拔管后10 min(T5)的收缩压(SAP)、舒张压(DAP)、心率(HR)及心率-收缩压乘积(RPP),记录拔管过程中血氧饱和度(SpO2)、心电图(ECG)变化,明显呛咳及拔管后咽痛、咽部异物感、声音嘶哑例数。结果三组患者SAP、DAP、HR及RPP在T1均明显低于T0(P<0.05),S组与C组SAP、DAP、HR及RPP在T2、T3、T4较T0均明显升高(P<0.05);与C组比较,SL组SAP、DAP、HR及RPP在T2、T3、T4均显著降低(P<0.05)。与C组比较,SL组拔管时呛咳、拔管后咽痛发生率明显降低(P<0.05),但拔管后咽喉部异物感发生率明显增高(P<0.05);各组间拔管后声音嘶哑例数无统计学差异(P>0.05)。结论冠心病患者全麻拔管前经喷雾气管导管进行气道表面麻醉能有效抑制拔管期心血管反应,控制心肌氧耗,气道并发症少,安全可行。

Clinical observation of spraying-endotracheal tube for relieving cardiovascular reactions of patients with coronary heart disease during periextubation period

Objective To observe the hemodynamic effects of spraying-endotracheal tube on patients with coronary heart disease(CHD) and other adverse effects during periextubation period.Methods Sixty patients,who were scheduled for operations with tracheal intubation under general anesthesia,were randomized to spraying-endotracheal tube with lidocaine topical anesthesia group(Group SL),spraying-endotracheal tube with saline group(Group S) or normal endotracheal tube group(Group C).Hemodynamic data of systolic arterial pressure(SAP),diastolic arterial pressure(DAP),heart rate(HR) and rate-pressure product(RPP) were recorded at the time of T0(base line before induction),T1(just before extubation),T2(extubation),T3(1 min after extubation),T4(2 min after extubation),and T5(10 min after extubation).Changes in saturation of pulse oxygen(SpO2),as well as electrocardiogram(ECG),number of obvious bucking cases,pharyngalgia,pharyngeal paraesthesia and hoarse voice,were also recorded.Results SAP,DAP,HR and RPP of all the groups at T1 were significantly lower than that at T0(P<0.05).SAP,DAP,HR and RPP of Group S and Group C at T2,T3 and T4 were significantly higher than that at T0(P<0.05).Compared with Group C,SAP,DAP,HR of and RPP of Group SL were remarkably lower at T2,T3 and T4(P<0.05).Compared with Group C,the incidence of extubation bucking and pot-extubat-ion pharyngalgia were significantly lower(P<0.05) but more cases of pharyngeal paraesthesia occurred(P<0.05) in Group SL.Incidence rate of hoarse voice in each group was of no difference(P>0.05).Conclusion Topical anesthesia of airway via spraying-endotracheal tube could effectively inhibit cardiovascular reaction,restrain myocardial oxygen consumption,and bring about rare airway complications in patients with CHD.