右美托咪啶联合利多卡因胶浆对双腔气管插管患者拔管应激反应的影响

目的评价右美托咪啶联合利多卡因胶浆对双腔气管插管患者拔管应激反应的影响。方法择期行开胸肺叶切除术患者100例，ASA分级I或Ⅱ级，随机分为4组（n=251：对照组、右美托咪啶组、利多卡因胶浆组及联合治疗组（右美托咪啶联合利多卡因胶浆治疗组）。于静脉输注右美托咪啶前（T0）、DLT拔管前（T1）、拔管后5min（T2）、拔管后10min（T3）测定血浆中肾上腺素和去甲肾上腺素水平，记录各时点MAP和收率（HR），评估拔管时呛咳程度。结果与T0时比较，4组患者T1时血浆肾上腺素及去甲肾上腺素水平升高，对照组、右美托咪啶组和利多卡因胶浆组T1时MAP、HR升高，对照组T2．3时各指标水平升高（P＜0．05）；与对照组比较，右美托咪啶组、利多卡因胶浆组及联合治疗组T1、T2、T3时各指标水平及拔管时呛咳程度降低（P＜0．05）；与联合治疗组比较，右美托咪啶组和利多卡因胶浆组T1时各指标水平及拔管时呛咳程度升高（P＜0．05）。结论右美托咪啶联合利多卡因胶浆可减轻双腔气管插管患者拔管时的应激反应。

Effects of Dexmedetomidine Combined with Lidocaine Mucilage on Extubation Response in Patients Receiving Double Lumen Endotracheal Intubation

OBJECTIVE To evaluate the effects of dexmedetomidine combined with lidocaine mucilage on extubation response in patients receiving double lumen endotracheal intubation. METHODS One hundred ASA ⅠorⅡ patients scheduled for pulmonary lobectomy under general anesthesia were randomly divided into 4 groups（n=25 each）： control group, dexmedetomidine group, lidocaine mucilage group and combine treatment group（dexmedetomidine combined with lidocaine mucilage）. The plasma epinephrine and norepinephrine level were detected and MBP and HR were recorded immediately before iv infusion of dexmedetomidine（T0）, immediately before extubation of DLT（T1）, at 5 rain after extubation（T2）, at 10 min after extubation（T3）. The severity of cough was assessed. RESULTS The level of plasma epinephrine and norepinephrine in four groups, MAP and HR in control group, dexmedetomidine group and lidocaine mucilage group were significantly increased at T1 than at To, all indexes in control group were significantly increased at T2, T3 than at T0（P〈0.05）. Compared with control group, all indexes at T1, T2, T3 and severity of cough during extubation in dexmedetomidine group, lidocaine mucilage group and combine treatment group were significantly decreased （P〈0.05）. Compared with combine treatment group, all indexes at T1 and severity of cough during extubation in dexmedetomidine group and lidocaine mucilage group were significantly increased （P〈0.05）. CONCLUSION Dexmedetomidine combined with lidocaine mucilage can alleviate the response of extubation in patients receiving double lumen endotraeheal intubation.