环甲膜穿刺丁卡因表面麻醉在ICU患者气管插管中的应用

目的探讨环甲膜穿刺丁卡因表面麻醉在ICU患者气管插管中的可行性、安全性及有效性。方法纳入2009年11月至2010年2月四川大学华西医院中心ICU内41例需要气管插管的患者,随机分为环甲膜穿刺丁卡因表面麻醉组（丁卡因组）和对照组。记录基础生命体征,插管时、插管后1 min、5 min时血流动力学变化,低氧发生率,插管时间,插管成功率,插管后低血压发生率,全麻药物用量及相关并发症。结果丁卡因组气管插管时和插管后1 min的心率（HR）、平均动脉压（MAP）变化率及心率收缩压乘积（RPP）均显著低于对照组（P〈0.05）。两组患者插管成功率、低氧发生率无显著差异（P〉0.05）。丁卡因组诱导期间全麻药（异丙酚）用量、插管后低血压发生率、血管活性药物使用总量均明显小于对照组（P〈0.05）。丁卡因组所有病例环甲膜穿刺均一次性操作成功,穿刺时间不超过1 min,无一例出现局麻药过敏、中毒反应、皮下或纵隔积气、食道损伤和气胸等并发症,所有患者气管插管时无死亡。结论环甲膜穿刺丁卡因表面麻醉在ICU患者气管插管中可以减轻气管插管时患者血流动力学的波动,减少插管后低血压发生率,减少全麻药、血管活性药物的用量,是一种安全、有效、快速、简便易行和微创的操作方法,必要时可选择性使用。

Application of Tetracaine Sprayed through Thyrocricoid Puncture before Intubation in Intensive Care Unit

Objective To study the application,safety and efficiency of tetracaine sprayed through thyrocricoid puncture before intubation in intensive care unit(ICU).Methods Forty-one patients ready to undergo intubation,admitted in ICU from November 2009 to February 2010,were recruited in the study.They were randomly divided into a tetracaine group and a control group.2% tetracaine was sprayed through thyrocricoid puncture before intubation in the tetracaine group but not in the control group.The hemodynamic variables and SpO2 at baseline(T0),beginning of intubation(T1),1 min after intubation(T2),and 5 min after intubation(T3) were recorded.The dosage of propofol and vasoactive agents,the incidence of hypotension,the times of intubation,and complications were also recorded.Results The variance rate about heart rate(HR),mean arterial pressure(MAP) and rate pressure production on time of T1 and T2 were significantly lower in the tetracaine group than those in the control group(P<0.05).There was no difference about the incidence of successful intubation and hypoxia(P>0.05).The dosage of propofol during induction and vasoactive agents after intubation in the tetracaine group were less than those in the control group(P<0.05).The incidence of hypotension after intubation in the tetracaine group was 35%,which was lower than 61.9% in the control group(P<0.05).There was no any complications and adverse accidents in the tetracaine group.Conclusions It is safe and simple to spray tetracaine through thyrocricoid puncture before intubation in ICU,which can effectively stabilize the hemodynamics,and decrease the dosages of propofol and vasoactive agents.