利多卡因在OSAHS患者术后的应用分析

发布时间：2018-07-03 17:46

本文选题：阻塞性睡眠呼吸暂停低通气综合征 + 韩式-悬雍垂腭咽成形术　；参考：《延安大学》2017年硕士论文

【摘要】：目的:本研究拟对OSAHS行H-UPPP术后的患者雾化吸入利多卡因,并静脉小量滴注利多卡因,探讨利多卡因对患者术后咽喉疼痛、吞咽困难、咽喉肿胀、细胞因子等方面的保护作用,同时对咽喉麻木感等不良反应予以评价。方法:1.将拟住院行H-UPPP术的OSAHS患者随机分为两组,分别为对照组和处理组,对照组为30例,处理组为40例。对照组用地塞米松5mg+生理盐水9ml氧气雾化吸入,处理组用利多卡因100mg+地塞米松5mg+生理盐水4ml氧气雾化吸入,分别在术后麻醉清晰返回病房后即刻(0h)、术后返回病房3h雾化吸入(3h),每次雾化时间30min内完成,并分别在返回病房后即刻(0h)、1h(雾化结束后30min)、2h、3h、4h(第二次雾化结束后30min)、5h、6h从疼痛程度、吞咽困难程度、咽喉肿胀程度予以视觉模拟评分(VAS),在1h时予以咽喉麻木感、疼痛/不适缓解感评估。2.处理组在术后24h内12h/次静脉滴注利多卡因,100mg/次,对照组予以同等剂量生理盐水。对照组和处理组分别在术前24h、术后24h抽血,并用ELisa试剂盒检测血清细胞因子IL-6、IL-27、IL-33、8-iso-PGF2α和代谢产物25-OH-VD的变化情况。3.记录应用利多卡因结束后24h内患者出现的任何不良反应。结果:1.对照组、处理组术后即刻(0h)疼痛平均分值为5.80±0.76分和6.00±0.91分,雾化后(1h)疼痛平均分值为6.10±0.55分和3.90±1.39分,1h时处理组疼痛分值较对照组显著降低,差异有统计学意义(P≤0.001)。术后即刻(0h)对照组、处理组吞咽困难平均距离为5.50±0.34cm和5.48±0.35cm,雾化后30 min(1h)吞咽困难平均距离为5.64±0.31cm和3.09±0.42cm,1h时处理组吞咽困难距离较对照组显著缩短,差异有统计学意义(P≤0.001)。术后即刻(0h)对照组、处理组咽喉肿胀平均距离为7.49±0.42cm和7.58±0.61cm,雾化后30 min(1h)咽喉肿胀平均距离为7.56±0.50cm和3.96±0.46cm,1h时处理组咽喉肿胀距离较对照组显著缩短,差异有统计学意义(P≤0.001)。在雾化后即刻(1h)对照组有2例疼痛/不适感有一点缓解,其余患者无明显改善。处理组中有3例小部分缓解,19例已缓解一半,15例有大部分缓解,3例几乎完全缓解。处理组的缓解率为100%,对照组缓解率为6.67%,差异有统计学意义(P≤0.001)。在雾化后即刻(1h)对照组仅有1例有中度麻木感,2例有轻度麻木感,其余患者均未出现咽喉麻木感觉。处理组中有31例出现了轻度麻木,7例中度麻木,1例出现了重度麻木,1例未出现麻木感,处理组出现麻木感的概率为98%,对照组出现麻木感的概率为10%,差异有统计学意义(P≤0.001)。2.对照组咽喉疼痛、吞咽困难、咽喉肿胀0-6h评分的AUC的平均值分别为39.30±2.51、37.80±1.85、46.34±1.84,处理组咽喉疼痛、吞咽困难、咽喉肿胀0-6h评分的AUC的平均值分别为23.20±3.34、19.26±1.64、26.24±2.82,两组AUC差异有统计学意义(P≤0.001)。3.对照组与处理组术前血清IL-6分别为1.31±0.03pg/ml和1.31±0.06pg/ml,术后24h分别为3.02±0.08pg/ml和1.40±0.11pg/ml,两组差异有统计学意义(P≤0.001)。IL-27术前浓度分别为6.40±0.33pg/ml和6.69±0.12pg/ml,术后24h分别为7.78±0.36pg/ml和6.74±0.39pg/ml,两组差异有统计学意义(P≤0.001)。IL-33术前浓度分别为39.84±1.38pg/ml和38.16±1.51pg/ml,术后24h分别为40.68±1.16pg/ml和33.32±1.51pg/ml,两组差异有统计学意义(P≤0.001)。8-iso-PGF2α术前浓度分别为0.46±0.02pg/ml和0.17±0.02pg/ml,术后24h分别为8.09±0.47pg/ml和0.46±0.02pg/ml,两组差异有统计学意义(P≤0.001)。25-OH-VD术前浓度分别为4.61±0.03ng/ml和4.01±0.16ng/ml,术后24h分别为5.01±0.28ng/ml和2.67±0.07ng/ml,两组差异有统计学意义(P≤0.001)。4.应用利多卡因结束后24内未记录到任何毒性反应。结论:1.利多卡因能显著缓解OSAHS患者H-UPPP术后0-6h时咽喉疼痛、吞咽困难、咽喉肿胀等术区不适;2.利多卡因能显著降低OSAHS患者H-UPPP术后细胞因子IL-6、IL-27、IL-33、8-iso-PGF2α和25-OH-VD的升高,减少术后应激反应;3.OSAHS患者H-UPPP术后应用利多卡因未记录到任何毒性反应,临床应用安全有效,值得推广。
[Abstract]:Objective: To investigate the effects of lidocaine inhalation and intravenous drip of lidocaine on OSAHS patients after H-UPPP operation, and to explore the protective effect of lidocaine on postoperative sore throat, dysphagia, throat swelling and cytokine, and to evaluate the adverse reactions of pharynx and larynx. Methods: 1. will be hospitalized for H-UP The OSAHS patients with PP were randomly divided into two groups, the control group and the treatment group, the control group was 30 cases, the treatment group was 40 cases. The control group was inhaled with dexamethasone 5mg+ saline 9ml oxygen, the treatment group was treated with lidocaine 100mg+ dexamethasone 5mg+ physiological saline 4ml oxygen atomization inhalation, and immediately after the postoperative anesthesia returned to the ward immediately after the operation (0h) respectively. After the operation, 3h atomization inhalation (3H) was returned to the ward, and each time of atomization was completed within 30min, and immediately after returning to the ward (0h), 1H (30min after atomization), 2h, 3h, 4H (30min) and 5h after the second atomization, 6h from the degree of pain, dysphagia, throat swelling degree. The.2. treatment group had 12h/ intravenous drip of lidocaine, 100mg/ times and the same dose of physiological saline in the control group after 24h. The control group and the treatment group were 24h before operation, 24h after operation, and the ELisa reagent box was used to detect the changes of serum cytokine IL-6, IL-27, IL-33,8-iso-PGF2 a, and metabolite 25-OH-VD. In the 1. control group, the average score of immediate (0h) pain in the 1. control group was 5.80 + 0.76 and 6 + 0.91, and the average score of pain after atomization (1H) was 6.10 + 0.55 and 3.90 + 1.39. The pain score of the treatment group was significantly lower than that of the control group, and the difference was statistically significant. Learning significance (P < 0.001). The average distance of dysphagia in the treatment group was 5.50 + 0.34cm and 5.48 + 0.35cm in the treatment group, and the average distance of dysphagia 30 min (1H) after atomization was 5.64 + 0.31cm and 3.09 + 0.42cm, and the dysphagia distance in the treatment group was significantly shorter than that of the control group at 1H (P < < 0.001). The average distance of throat swelling in the treatment group was 7.49 + 0.42cm and 7.58 0.61cm, and the average distance of throat swelling in 30 min (1H) after atomization was 7.56 + 0.50cm and 3.96 + 0.46cm. The throat swelling distance of the treatment group was significantly shorter than that of the control group (P < 0.001). There were 2 cases of pain / discomfort in the control group immediately after atomization (1H). There were 3 minor remission in the treatment group, 19 in half remission, 15 in the treatment group and 3 in almost complete remission. The remission rate of the treatment group was 100% and the control group was 6.67%, the difference was statistically significant (P < 0.001). Only 1 cases in the control group had moderate numbness and 2 cases in the control group after the fogization. There were 31 cases of mild numbness in the treatment group, 7 moderate numbness, 1 cases of severe numbness, 1 cases of numbness, the probability of numbness in the treatment group was 98%, the probability of numbness in the control group was 10%, and the difference was statistically significant (P < 0.001).2. control group. The average value of AUC for throat pain, dysphagia and throat swelling 0-6h score was 39.30 + 2.51,37.80 + 1.85,46.34 + 1.84 respectively. The average value of AUC in the treatment group, throat pain, dysphagia and laryngology swelling 0-6h score was 23.20 + 3.34,19.26 + 1.64,26.24 + 2.82 respectively, two groups of AUC difference was statistically significant (P < < 0.001) and.3. control group and treatment group The preoperative serum IL-6 was 1.31 + 0.03pg/ml and 1.31 + 0.06pg/ml respectively. The postoperative 24h was 3.02 + 0.08pg/ml and 1.40 + 0.11pg/ml respectively. The two groups were statistically significant (P < 0.001). The preoperative concentration was 6.40 + 0.33pg/ml and 6.69 + 0.12pg/ml respectively. The postoperatively 24h was 7.78 + 0.36pg/ and 6.74 +, and the two groups were statistically significant. The preoperative concentration of.IL-33 was 39.84 + 1.38pg/ml and 38.16 + 1.51pg/ml respectively. The postoperative 24h was 40.68 + 1.16pg/ml and 33.32 + 1.51pg/ml respectively. The difference between the two groups was statistically significant (P < 0.001). The preoperative concentration of.8-iso-PGF2 a was 0.46 + 0.02pg/ml and 0.17 + 0.02pg/ml respectively. The 24h was 8.09 + and 0.46 +, respectively, and the difference between two groups was different after operation. Statistical significance (P < 0.001) the preoperative concentration of.25-OH-VD was 4.61 + 0.03ng/ml and 4.01 + 0.16ng/ml respectively, 24h was 5.01 + 0.28ng/ml and 2.67 + 0.07ng/ml, respectively. The two groups were statistically significant (P < 0.001) and.4. application of lidocaine at the end of 24 did not record any toxic reaction. Conclusion: 1. lidocaine can significantly alleviate the OSAHS patients. H-UPPP postoperative 0-6h in the pharynx and larynx pain, dysphagia, throat swelling and other surgical areas discomfort, 2. lidocaine can significantly reduce the growth of cytokines IL-6, IL-27, IL-33,8-iso-PGF2 A and 25-OH-VD after H-UPPP operation in OSAHS patients, and reduce postoperative stress response; 3.OSAHS patients should use lidocaine without any toxic reaction, clinical application after H-UPPP operation. It is safe and effective, and it is worth promoting.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R766.9

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