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[1%丁卡因局部麻醉对显微喉镜手术血流动力学反应的影响]

[Effects of topical anesthesia with 1% tetracaine on hemodynamic responses in microlaryngosurgery].

作者信息

Wei Z, Xin Y, Wu L L, Xi C H, Wang G Y

机构信息

Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2022 Jun 7;102(21):1590-1595. doi: 10.3760/cma.j.cn112137-20220131-00227.

Abstract

To observe the effects of topical anesthesia with 1% tetracaine on hemodynamic responses in general anesthesia patients undergoing microlaryngosurgery. From October 2021 to December 2021, 92 patients (46 males and 46 females) in Beijing Tongren Hospital, with a median age [ (, )] of 51 (42, 57) years who scheduled for microlaryngosurgery under general anesthesia, were divided into two groups (=46 in each group) using the random number table method. Group T received topical anesthesia with 1% tetracaine at the root of the tongue and epiglottis and glottis on the basis of general intravenous anesthesia induction, with 0.5 ml at each position, while the control group (group C) received equal volume of normal saline. Heart rate (HR) and mean arterial pressure (MAP) were recorded at the time of patients entering the operating room (baseline), after induction, after intubation, immediately after suspending laryngoscopy, 1 min after suspending laryngoscopy, 3 min after suspending laryngoscopy, 5 min after suspending laryngoscopy and immediately after extubation. The recovery profiles, including time to recover breathing, time to open eyes, time to extubation and adverse reactions were evaluated during recovery period. The MAP of patients in group T at baseline, after induction, after intubation, immediately after suspending laryngoscopy, 1 min after suspending laryngoscopy, 3 min after suspending laryngoscopy, 5 min after suspending laryngoscopy and immediately after extubation were (99.4±12.9), (78.5±8.8), (79.2±10.2), (100.6±17.0), (101.9±14.7), (100.8±13.9), (97.4±12.1), (107.3±16.8) mmHg (1 mmH=0.133 kPa), respectively, while in group C were (99.5±11.6), (80.9±12.8), (90.5±16.0), (109.5±20.4), (108.0±18.9), (103.7±15.5), (100.1±13.3), (114.2±17.3) mmHg, respectively. The two critical time points of MAP after intubation and immediately suspending laryngoscopy in group C were significantly higher than group T (0.05).The HR of patients in group T at baseline, after induction, after intubation, immediately after suspending laryngoscopy, 1 min after suspending laryngoscopy, 3 min after suspending laryngoscopy, 5 min after suspending laryngoscopy and immediately after extubation was (71.3±10.6), (66.0±10.1), (69.5±11.4), (61.3±14.2), (69.8±9.8), (71.0±10.6), (70.6±11.0), (78.8±11.6) bmp, respectively, while in group C were (73.1±10.9), (67.8±9.9), (79.5±12.9), (57.1±18.1), (69.2±12.8), (71.4±11.7), (70.7±11.5), (85.3±13.0) bmp, respectively. The two critical time points of HR after intubation and after extubation in group C were significantly higher than that of group T (0.05). The time to recover breathing in the two groups was (11.8±3.5) min and (11.3±4.6) min, respectively. The time to open eyes was (12.0±3.3) min and (11.5±5.0) min, respectively. The time to extubation was (13.2±3.7) min and (12.6±4.9) min, respectively. There were no statistically significant difference in time to recovery between the two groups (>0.05). Likewise, there were no toxic reactions to local anesthetics, respiratory depression, hypoxemia, laryngospasm and cough occurred in either group. Topical anesthesia with 1% tetracaine can effectively reduce the hemodynamic changes without influencing patient's recovery, and does not increase the incidence of adverse reactions.

摘要

观察1%丁卡因表面麻醉对接受显微喉镜手术的全身麻醉患者血流动力学反应的影响。2021年10月至2021年12月,北京同仁医院92例计划在全身麻醉下进行显微喉镜手术的患者(男46例,女46例),年龄中位数[(,)]为51(42,57)岁,采用随机数字表法分为两组(每组 = 46例)。T组在全身静脉麻醉诱导的基础上,于舌根、会厌和声门处给予1%丁卡因表面麻醉,每个部位0.5 ml,而对照组(C组)给予等量生理盐水。记录患者进入手术室时(基线)、诱导后、插管后、喉镜检查结束即刻、喉镜检查结束后1分钟、喉镜检查结束后3分钟、喉镜检查结束后5分钟以及拔管后即刻的心率(HR)和平均动脉压(MAP)。在恢复期评估恢复情况,包括恢复呼吸时间、睁眼时间、拔管时间及不良反应。T组患者在基线、诱导后、插管后、喉镜检查结束即刻、喉镜检查结束后1分钟、喉镜检查结束后3分钟、喉镜检查结束后5分钟以及拔管后即刻的MAP分别为(99.4±12.9)、(78.5±8.8)、(79.2±10.2)、(100.6±17.0)、(101.9±14.7)、(100.8±13.9)、(97.4±12.1)、(107.3±16.8)mmHg(1 mmHg = 0.133 kPa),而C组分别为(99.5±11.6)、(80.9±12.8)、(90.5±16.0)、(109.5±20.4)、(108.0±18.9)、(103.7±15.5)、(100.1±13.3)、(114.2±17.3)mmHg。C组插管后及喉镜检查结束即刻MAP的两个关键时间点显著高于T组(P < 0.05)。T组患者在基线、诱导后、插管后、喉镜检查结束即刻、喉镜检查结束后1分钟、喉镜检查结束后3分钟、喉镜检查结束后5分钟以及拔管后即刻的HR分别为(71.3±10.6)、(66.0±10.1)、(69.5±11.4)、(61.3±14.2)、(69.8±9.8)、(71.0±10.6)、(70.6±11.0)、(78.8±11.6)次/分钟,而C组分别为(73.1±10.9)、(67.8±9.9)、(79.5±12.9)、(57.1±18.1)、(69.2±12.8)、(71.4±11.7)、(70.7±11.5)、(85.3±13.0)次/分钟。C组插管后及拔管后HR的两个关键时间点显著高于T组(P < 0.05)。两组恢复呼吸时间分别为(11.8±3.5)分钟和(11.3±4.6)分钟。睁眼时间分别为(12.0±3.3)分钟和(11.5±5.0)分钟。拔管时间分别为(13.2±3.7)分钟和(12.6±4.9)分钟。两组恢复时间差异无统计学意义(P > 0.05)。同样,两组均未出现局部麻醉药中毒反应、呼吸抑制、低氧血症、喉痉挛及咳嗽。1%丁卡因表面麻醉可有效减轻血流动力学变化,不影响患者恢复,且不增加不良反应发生率。

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