2018 年第 2 期 第 13 卷

右美托咪定联合利多卡因表面麻醉用于支撑喉镜声带手术的临床效果

作者：傅志玲张泽

英文作者：

单位：110004沈阳，中国医科大学附属盛京医院麻醉一科（傅志玲）；110300沈阳739医院麻醉科（张泽）

英文单位：

关键词：支撑喉镜声带手术；右旋美托咪定；利多卡因；表面麻醉

英文关键词：

• 摘要：

• 目的    观察右美托咪定联合利多卡因表面麻醉用于支撑喉镜声带手术的临床效果。方法    选取2016年10月到2017年8月在中国医科大学附属盛京医院择期行支撑喉镜下声带息肉手术的患者90例。按随机数字表法将患者分为右美托咪定组（D组）、利多卡因组（L组）、右美托咪定+利多卡因组（D+L组），每组30例，麻醉时分别使用相应药物。记录患者入室时（T1）、插管前（T2）、插管时（T3）、支撑喉镜置入时（T4）、支撑喉镜置入后3 min（T5）的收缩压、舒张压和心率，记录气管插管拔管时间、患者术后Riker镇静-躁动评分和Ramsay镇静评分，比较3组恶心呕吐、迟发型呼吸抑制等不良反应的发生率。结果    3组手术时间差异无统计学意义（P>0.05）。3组患者T1时收缩压、舒张压、心率差异无统计学意义（P＞0.05）。3组T2时收缩压、舒张压、心率明显低于T1 时（P＜0.05）；D组、L组T3～T5时收缩压、舒张压、心率明显高于T2时（P＜0.05），D+L组T3～T5时收缩压、舒张压、心率与T2时比较差异无统计学意义［（107±5）、（118±6）、（113±6）mmHg（1 mmHg=0.133 kPa）比（106±8）mmHg，（64±8）、（66±10）、（63±8）mmHg比（60±6）mmHg，（65±6）、（62±8）、（66±5）次/min比（58±6）次/min］（P＞0.05）。D+L组T3～T5时收缩压、舒张压、心率明显低于D组、L组，差异有统计学意义（P＜0.05）。D+L组和D组Riker镇静-躁动评分明显低于L组［（0.9±0.5）、（0.9±0.4）分比（2.0±0.7）分］，D+L组和D组Ramsay镇静评分明显高于L组［（2.4±0.5）、（2.0±0.8）分比（1.4±0.5）分］，差异均有统计学意义（均P<0.05）。3组恶心呕吐的发生率差异无统计学意义（P>0.05），均无迟发型呼吸抑制发生。结论    右美托咪定联合利多卡因表面麻醉用于支撑喉镜下声带手术能进一步减轻麻醉气管插管和手术操作造成的血流动力学不稳定，减少麻醉恢复期躁动，并且不增加不良反应发生率。

• Clinical effect of dexmedetomidine combined with lidocaine surface anesthesia on laryngoscopic vocal cord surgery

  Fu Zhiling, Zhang Ze

  The First Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang 110004, China(Fu ZL); Department of Anesthesiology, Shenyang 739 Hospital, Shenyang 110300, China

  Corresponding author: Fu Zhiling, Email: 18940258057@163.com

  【Abstract】Objective    To observe the clinical effect of dexmedetomidine combined with lidocaine surface anesthesia on laryngoscopic vocal cord surgery. Methods    Ninety patients undergoing vocal cord surgery from October 2016 to August 2017 in Shengjing Hospital of China Medical University were randomly divided into group D(dexmedetomidine surface anesthesia), group L(lidocaine surface anesthesia) and group D＋L(dexmedetomidine plus lidocaine surface anesthesia), with 30 cases in each group. Systolic blood pressure(SBP), diastolic blood pressure(DBP) and heart rate(HR) were recorded before operation(T1), before intubation(T2), during intubation(T3), during laryngoscope placement(T4) and 3 min after laryngoscope placement(T5). Extubation time, postoperative Riker sedation-agitation score and Ramsay sedation score, incidences of nausea, vomiting and delayed respiratory depression were analyzed. Results    There were no significant differences of operation time and SBP, DBP, HR at T1 among 3 groups(P>0.05). SBP, DBP and HR at T2 were significantly lower than those at T1 in all groups(P<0.05); SBP, DBP and HR at T3-T5 were significantly higher than those at T2 in group D and group L(P<0.05); SBP, DBP and HR at T3-T5 in group D＋L showed no significant differences compared to those at T2［（107±5）,（118±6）,（113±6）mmHg vs （106±8）mmHg; （64±8）,（66±10）,（63±8）mmHg vs （60±6）mmHg; （65±6）,（62±8）,（66±5）times/min vs （58±6）times/min］（P＞0.05）. SBP, DBP and HR at T3-T5 in group D+L were significantly lower than those in group D and group L(P<0.05). The Riker sedation-agitation score in group D+L and group D was significantly lower than that in group L［（0.9±0.5）,（0.9±0.4）points vs （2.0±0.7）points］; the Ramsay sedation score in group D+L and group D was significantly higher than that in group L［（2.4±0.5）,（2.0±0.8）scores vs （1.4±0.5）scores］(P<0.05). There was no significant difference of incidence of nausea and vomiting among groups(P>0.05), and no delayed respiratory depression occurred in all groups. Conclusion    Combined use of dexmedetomidine and lidocaine surface anesthesia for laryngoscopic vocal cord surgery can improve hemodynamic stability during intubation and operation, reduce restlessness during anesthesia recovery without increasing adverse reactions.

  【Key words】Laryngoscope surgery;Dexmedetomidine;Lidocaine;Surface anesthesia