中国基层医药
中國基層醫藥
중국기층의약
Chinese Journal of Primary Medicine and Pharmacy
2015年
19期
2916-2918
,共3页
利多卡因%超声雾化%环甲膜穿刺%清醒插管%体位
利多卡因%超聲霧化%環甲膜穿刺%清醒插管%體位
리다잡인%초성무화%배갑막천자%청성삽관%체위
Lidocaine%Ultrasonic atomization%Cricothyroid membrane puncture%Awake endotracheal intuba-tion%Posture
目的：探讨利多卡因超声雾化吸入气道表面麻醉下清醒气管插管在患者自主摆放手术体位中应用的可行性。方法选择68例需择期行全身麻醉下俯卧位手术的患者，随机方法分为对照组及观察组，每组为34例，分别采用环甲膜穿刺和面罩吸入2％利多卡因超声雾化气体进行气道表面麻醉及清醒气管插管，操作者完成气管插管后患者根据自身的舒适度配合医务人员摆放俯卧位。观察患者气管插管前后不同时间点：基础状态（T0）、气管插管即刻（T1）、插管后3 min（T2）以及翻身后即刻（T3）四个时相的平均动脉压（MAP）和心率（HR），并观察气管插管时呛咳反射发生情况。术后随访患者对气道表面麻醉效果及清醒气管插管的耐受性。结果两组患者均能顺利完成清醒气管插管及自主摆放俯卧位。观察组与对照组相比，两组患者 MAP 和 HR 数据在气管插管和体位摆放各个时相差异均无统计学意义（均 P ＞0．05）。两组患者气道表面麻醉时间、气管插管时间及呛咳反应发生率比较差异均无统计学意义（均 P ＞0．05）。结论利多卡因超声雾化吸入气道表面麻醉下清醒气管插管的方法简单实用，在患者自主摆放手术体位中应用有效可行，可以替代创伤性较大的环甲膜穿刺表面麻醉。
目的：探討利多卡因超聲霧化吸入氣道錶麵痳醉下清醒氣管插管在患者自主襬放手術體位中應用的可行性。方法選擇68例需擇期行全身痳醉下俯臥位手術的患者，隨機方法分為對照組及觀察組，每組為34例，分彆採用環甲膜穿刺和麵罩吸入2％利多卡因超聲霧化氣體進行氣道錶麵痳醉及清醒氣管插管，操作者完成氣管插管後患者根據自身的舒適度配閤醫務人員襬放俯臥位。觀察患者氣管插管前後不同時間點：基礎狀態（T0）、氣管插管即刻（T1）、插管後3 min（T2）以及翻身後即刻（T3）四箇時相的平均動脈壓（MAP）和心率（HR），併觀察氣管插管時嗆咳反射髮生情況。術後隨訪患者對氣道錶麵痳醉效果及清醒氣管插管的耐受性。結果兩組患者均能順利完成清醒氣管插管及自主襬放俯臥位。觀察組與對照組相比，兩組患者 MAP 和 HR 數據在氣管插管和體位襬放各箇時相差異均無統計學意義（均 P ＞0．05）。兩組患者氣道錶麵痳醉時間、氣管插管時間及嗆咳反應髮生率比較差異均無統計學意義（均 P ＞0．05）。結論利多卡因超聲霧化吸入氣道錶麵痳醉下清醒氣管插管的方法簡單實用，在患者自主襬放手術體位中應用有效可行，可以替代創傷性較大的環甲膜穿刺錶麵痳醉。
목적：탐토리다잡인초성무화흡입기도표면마취하청성기관삽관재환자자주파방수술체위중응용적가행성。방법선택68례수택기행전신마취하부와위수술적환자，수궤방법분위대조조급관찰조，매조위34례，분별채용배갑막천자화면조흡입2％리다잡인초성무화기체진행기도표면마취급청성기관삽관，조작자완성기관삽관후환자근거자신적서괄도배합의무인원파방부와위。관찰환자기관삽관전후불동시간점：기출상태（T0）、기관삽관즉각（T1）、삽관후3 min（T2）이급번신후즉각（T3）사개시상적평균동맥압（MAP）화심솔（HR），병관찰기관삽관시창해반사발생정황。술후수방환자대기도표면마취효과급청성기관삽관적내수성。결과량조환자균능순리완성청성기관삽관급자주파방부와위。관찰조여대조조상비，량조환자 MAP 화 HR 수거재기관삽관화체위파방각개시상차이균무통계학의의（균 P ＞0．05）。량조환자기도표면마취시간、기관삽관시간급창해반응발생솔비교차이균무통계학의의（균 P ＞0．05）。결론리다잡인초성무화흡입기도표면마취하청성기관삽관적방법간단실용，재환자자주파방수술체위중응용유효가행，가이체대창상성교대적배갑막천자표면마취。
Objective To explore the feasibility of the ultrasonic atomization surface anesthesia with lido-caine for awake fiberoptic endotracheal intubation in patientsˊautonomous position -display before general anesthesia and to evaluate its advantages.Methods 68 adult patients who needed prone position for elective surgery under general anesthesia were selected and randomly divided into two groups,the control group and the treatment group,each group in 34 cases.In control group patients were received surface anesthesia of cricothyroid membrane puncture.In treatment group,nebulized 2% lidocaine with ultrasonic nebulizer was used for topical anesthesia.Patients lied in the prone position according to their own comfort with the guide of the medical staff in the waking state after an awake fiberoptic endotracheal intubation.The statistics of mean arterial pressure (MAP)and heart rate (HR)were recorded respectively in the basal state(T0),in the time instantly after intubations(T1 ),in the 3 minute after intubations(T2 ) and in the time instantly after the body turning(T3 ).Choking cough response were recorded during endotracheal intubation.Patients were asked the efficacy of surface anesthesia and the tolerance for awake intubation after operation.Results Patients in both two groups completed the whole process smoothly.MAP and HR had no signifi-cant differences between the two groups in the same time point (all P >0.05).There were no statistical significance between the two groups in choking cough response,the time of surface anesthesia and intubation,neither (all P >0.05).Conclusion The surface anesthesia with lidocaine by continuous ultrasonic atomizing inhalation is a good and simple method deserving generalization with plenty merits and is practicable for patients to display position autonomously. This method have the advantages of small operation,it will and can replace cricothyroid membrane puncture.
