苏醒期表面麻醉对围气管拔管期应激反应的影响

目的 探讨利用注药型气管插管注射表面麻醉药对咽喉气管内实施表面麻醉对患者苏醒拔管期应急反应的影响.方法 用注药型气管插管全麻手术患者40例,ASAⅠ或Ⅱ级,年龄25～54岁,BMI 22～26 kg/m2,在手术结束前约20 min停止麻药时随机分为试验组(注药组,n=20)和对照组(非注药组,n=20).试验组注射1％丁卡因共1.5 ml(声门上0.5 ml、声门下1 ml),对照组不注药.观察并测定患者苏醒拔管期间的应激反应参数.结果 与T0相比,拔管前5 min、0 min和拔管后0min、5 min,试验组SBP分别升高10％(P＜ 0.05)、12％(P＜ 0.05)、12％(P＜ 0.05)、4％(P＞0.05),对照组分别升高24％(P＜0.01)、26％(P＜ 0.01)、31％(P＜ 0.01)、8％(P＜0.05),组间相比P＜0.05 ～ 0.01.HR变化,与T0相比,拔管前后试验组基本没有变化,对照组T1、T2、TO分别升高24％(P＜ 0.01)、34％(P＜ 0.01)和40％(P＜0.01),组间相比P＜0.01.拔管后(T3)患者E、NE和Cor血浆水平试验组都明显低于对照组(P＜ 0.01).围拔管期试验组患者呛咳、挣扎、呕心呕吐的发生率明显比对照组发生率低(P＜0.01).结论 气管插管全麻苏醒拔管期的气管咽喉内表面麻醉,能有效地减轻患者的身心应激反应.

Stress responses during general anesthesia recovery and extubation after topical anesthesia to endotracheal-laryngopharynx

Objective To study the stress responses during recovery and extubation of the endotracheal intubation with injecting medicine to topical anesthesia for endotracheal and laryngopharynx.Methods Forty patients with general anesthesia tracheal intubation were included.Patients were given endotracheal intubation withmedicine injection.,Patients who were ASA grade Ⅰ ～ Ⅱ and aged 25～54 yr and BMI 22～26 kg/m2,were divided randomly into the experimental group (n=20) who were injected with a 1.5 ml (1 ml for endotracheal and 0.5 ml for laryngopharynx) of 1％ tetracaine to topical anesthesia and the control group (n=20) who were treated without medicine-injection.Patients' data of stress responses were taken during recovery and extubation.Results Compared with T0,SBP was increased 10％(P ＜ 0.05)、12％(P ＜ 0.05)、12％(P ＜ 0.05) and 4％(P ＞ 0.05) respectively in the experimental group,24％ (P ＜ 0.01) 、26％(P ＜ 0.01) 、31％ (P ＜.01) 、8％(P ＜ 0.05) in the control group,at 5 min、0 min before extubation and at 0 min、5 min after extubation.Comparison was been made between groups,P ＜ 0.05～0.01 was identified in the SBP.Compared with T0,no significant changes in the experimental,but were increased to 24％(P ＜ 0.01) 、34％(P ＜ 0.01)and 40％(P ＜ 0.01)in HR respectively in the control group.Compared between groups,P ＜ 0.05～0.01 in HR.The plasma levels of E,NE and Cor in the experimental group were significantly lesser (P ＜ 0.01) than those in the control group at T3.The incidence rates of Cough,struggle,nausea and vomiting in the experimental group were significantly lower (P ＜ 0.01) those in control group during the peri-extubation period.Conclusion It can effectively decrease patients' body and cardiovascular stress responses by topical anesthesia for endotracheal and laryngopharynx using endotracheal intubation with medicine injection during general anesthesia recovery and extubation.