三种表麻联合应用在颅脑手术中对全麻气管插管及拔管应激反应的影响

发布时间：2018-02-25 03:01

本文关键词： 麻醉气管插管颅脑手术应激反应　出处：《吉林大学》2015年硕士论文　论文类型：学位论文

【摘要】：研究背景：心血管不良反应是全麻插管常见的并发症，主要表现为血压升高，心率曾快。为减少和预防气管插管及拔管应激反应的发生，国内外医学界多采用加深麻醉，一种或两种呼吸道粘膜表面麻醉及药物预防等措施，但是关于三种表面麻醉方法联合应用对全麻气管插管及拔管应激反应的影响的研究尚较少。目的：观察2%利多卡因溶液咽喉黏膜及声门下喷雾与复方利多卡因乳膏联合应用在颅脑手术中抑制气管插管及拔管应激反应的效果。方法：择期进行开颅手术的患者90例（ASAⅠ或Ⅱ级），随机分为三组，每组30例。A组患者用2%的利多卡因溶液2ml行咽喉黏膜喷雾表面麻醉，然后用喉麻管给予生理盐水2ml声门下喷雾，在气管导管前端涂上腔道润滑剂2g后行气管插管；B组患者在2%利多卡因2ml咽喉黏膜喷雾表面麻醉后，2%利多卡因2ml通过喉麻管给予声门下喷雾，气管导管前端涂腔道润滑剂2g行气管插管；C组患者为2%利多卡因2ml咽喉黏膜喷雾表面麻醉，喉麻管给予2%利多卡因2ml声门下喷雾，于气管导管前端涂复方利多卡因乳膏2g后行气管插管。麻醉诱导均采用快诱导，静脉给予咪达唑仑0.05mg/kg、依托咪酯乳剂0.3mg/kg、芬太尼0.03mg/kg、苯磺顺阿曲库铵0.15mg/kg，待患者睫毛反射消失，面罩控制呼吸给氧去氮4min。达适当肌松后，用加强型气管导管（ID:女7.0mm，男7.5mm）行气管插管，接麻醉机行机械通气，潮气量8～10ml/kg，维持呼气末二氧化碳分压（PETCO2）35～45mmHg。麻醉维持用1%丙泊酚和盐酸瑞芬太尼，间断追加苯磺顺阿曲库铵，根据麻醉深度调整麻醉药用量，维持Narcotrend指数在30～60。术毕停止麻醉药输注，深麻醉下吸痰后将患者送入麻醉苏醒室，待患者自主呼吸恢复、SpO295%、潮气量5ml/kg，唤之可睁眼时由一名不知分组情况的麻醉医师拔除气管导管并收集资料。记录插管前（T0）、插管即刻（T1）、插管后3min（T2）、插管后5min（T3）、插管后10min（T4）、拔管即刻（T5）、拔管后3min（T6）以及拔管后5min（T7）各时点患者心率（HR）、收缩压（SBP）、舒张压（DBP）的变化，同时采集静脉血测各时点肾上腺素（AD）、去甲肾上腺素（NE）、血浆皮质醇（CORT）的含量。记录手术时间、麻醉时间，追踪并记录麻醉苏醒期患者躁动及拔管后24h咽喉疼痛的发生情况。结果： C组患者各时点HR、SBP、DBP的变化以及静脉血AD、NE、CORT的含量均明显低于A、B两组（p＜0.05），且苏醒期躁动及拔管后24h患者咽喉疼痛的发生率明显低于A、B两组（p＜0.05）。结论：在颅脑手术中，，三种表麻联合应用可有效降低气管插管反应的发生，提高患者对气管导管的耐受性。
[Abstract]:Background:. Cardiovascular adverse reactions are common complications of general anesthesia intubation, mainly manifested by high blood pressure and fast heart rate. In order to reduce and prevent the occurrence of endotracheal intubation and extubation stress reactions, intensive anesthesia is often used in domestic and foreign medical circles. One or two kinds of airway mucosal surface anesthesia and drug prevention measures, but the effect of three surface anesthetic methods on tracheal intubation and extubation stress response of general anesthesia is less studied. Objective:. To observe the effect of combined application of 2% lidocaine solution throat mucosal and subglottic spray and compound lidocaine cream on the stress response of tracheal intubation and extubation during craniocerebral surgery. Methods:. 90 patients undergoing elective craniotomy were randomly divided into three groups: group A (n = 30) was treated with 2 ml of lidocaine solution (2% ml), and then treated with 2 ml normal saline (2ml) under door spray with laryngeal anaesthesia tube. Endotracheal intubation group B was given 2% lidocaine through laryngeal anaesthesia after 2% lidocaine 2ml pharyngeal and laryngeal mucosal spray surface anesthesia, and 2 g of endotracheal lubricant was applied on the front end of trachea tube after endotracheal intubation, and the patients in group B were given subglottic spray through laryngeal anaesthesia tube. Endotracheal intubation group C was treated with 2% lidocaine 2ml larynx mucosal spray surface anesthesia, and 2% lidocaine 2ml subglottic spray was given to the laryngeal anaesthesia tube. Endotracheal intubation was performed after 2 g compound lidocaine cream was applied to the front end of tracheal tube. Anesthesia induction was done by quick induction, intravenous midazolam 0.05 mg / kg, etomidate emulsion 0.3 mg / kg, fentanyl 0.03 mg / kg, benzsulfoxide 0.15 mg / kg, and eyelash reflex disappeared. The mask controlled breathing for 4 minutes. After the proper muscle relaxation was achieved, the endotracheal intubation was performed with an enhanced tracheal tube ID-7.0mm for female and 7.5mm for male), and mechanical ventilation was performed by anaesthesia machine. 1% propofol and remifentanil hydrochloride were used in anesthesia maintenance, the dosage of anesthetic was adjusted according to the depth of anesthesia, and the Narcotrend index was maintained at 30 ~ 60.After the operation, 1% propofol and remifentanil hydrochloride were added to maintain the Narcotrend index at 30 ~ 60.The volume of tidal volume was 8 ~ 10ml / kg, and the Narcotrend index was maintained at 30 ~ 60.The anesthesia was maintained with 1% propofol and remifentanil hydrochloride. After sucking sputum under deep anesthesia, the patient is sent to the anaesthesia recovery room. When the patient was able to open his eyes, the tracheal catheter was pulled out by an anesthesiologist who did not know how to divide it into groups, and the data was collected. Before intubation, T0, T1, T2, T3, T4 and T4 were recorded before intubation, 3 min after intubation, 5 min after intubation, and 10 min after intubation, respectively. The changes of HRT, SBP, DBP in patients with T5, T6 (3 min after extubation) and T7 (5 min after extubation) were observed. At the same time, the contents of adrenocephalin, norepinephrine, plasma cortisol Cort were measured. The operation time, anesthesia time, restlessness of patients during anaesthesia recovery and the occurrence of pharynx and larynx pain 24 hours after extubation were recorded. Results:. The changes of SBP DBP and the content of ADNNECORT in group C were significantly lower than those in group A (P < 0.05), and the incidence of pharynx and larynx pain in group C was significantly lower than that in group A (P < 0.05). Conclusion:. In craniocerebral surgery, combined use of three kinds of epigastric anesthesia can effectively reduce the occurrence of tracheal intubation reaction and improve the patient's tolerance to tracheal catheter.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R614.2

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