七氟烷联合利多卡因在麻醉诱导插管中的应用
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摘要
目的探讨七氟烷联合利多卡因在麻醉诱导插管中的应用效果。方法选择2015年10月至2017年10月中国人民解放军第254医院接诊拟行下腹部手术的90例患者,通过随机数表法将患者分为观察组和对照组,每组45例,对照组给予七氟烷吸入进行麻醉诱导,观察组在对照组的基础上联合利多卡因进行麻醉诱导。比较两组患者诱导前、插管即刻、插管后1 min、5 min的平均动脉压(MAP)、心率(HR)、外周血管阻力(SVR)、每博输出量(SV)、每分输出量(CO)、峰值速度(VpK)和静射血时间百分比(ET)的变化及术后拔管期躁动、呛咳发生率。结果与诱导前比较,两组患者插管即刻、插管后1 min、5 min时的MAP、HR均有所降低,且观察组患者插管即刻、插管后1 min、5 min时的MAP、HR均明显高于对照组,差异均有统计学意义(P<0.05);与诱导前比较,两组患者插管即刻、插管后1 min、5 min时的SVR、SV、CO、VpK均有一定程度降低,ET明显升高,且观察组患者插管即刻、插管后1 min、5 min时的SVR、SV、CO、VpK明显高于对照组,ET明显低于对照组,差异均有统计学意义(P<0.05);观察组患者术后拔管期躁动、呛咳发生率分别为4.44%和15.56%,均明显低于对照组的22.22%和37.50%,差异均有统计学意义(P<0.05)。结论七氟烷联合利多卡因用于麻醉诱导插管中效果显著,其对血流动力学、心功能影响均较少,且可降低拔管期躁动、呛咳发生率,安全性高。
Objective To study the application effect of sevoflurane combined with lidocaine in anesthesia induction intubation. Methods A total of 90 patients who underwent lower abdomen operation in the 254 thHospital of Chinese People's Liberation Army from October 2015 to October 2017 were selected as research subjects. According to the random number table, the patients were divided into an observation group and a control group, with 45 cases in each group. The control group was given anesthetic induction with sevoflurane inhalation, and the observation group was combined with lidocaine for anesthesia induction on the basis of the control group. The changes of mean arterial pressure(MAP), heart rate(HR), peripheral vascular resistance(SVR), stroke volume(SV), cardiac output(CO), peak velocity(VpK) and percentage of ejection time(ET) at static period were compared between the two groups before induction,immediately after intubation, at 1 min and 5 min after intubation. The incidence of postoperative agitation and cough during extubation was also compared between the two groups. Results Compared with before induction, the MAP and HR of the two groups were all reduced at the time of immediately after intubation, and at 1 min and 5 min after intubation; the MAP and HR of the observation group were all higher than those of the control group immediately after intubation, and at 1 min and 5 min after intubation; the differences were statistically significant(P<0.05). Compared with before induction, the SVR, SV, CO and VpK of the two groups were all reduced at the time of immediately after intubation, at 1 min and 5 min after intubation, and the ET increased significantly; the SVR, SV, CO and VpK of the observation group were significantly higher than those of the control group immediately after intubation, at 1 min and5 min after intubation, and the ET was significantly lower than that of the control group; all differences were statistically significant(P<0.05). The incidence of postoperative agitation and cough during extubation in the observation group were 4.44% and 15.56%, respectively, which were significantly lower than those of the control group(22.22% and37.50%, respectively); both differences were statistically significant(P<0.05). Conclusion Sevoflurane combined with lidocaine is effective in anesthesia induction intubation, which has less influence on hemodynamics and cardiac function, and can reduce the incidence of agitation and cough during extubation, with high safety. It is worthy of clinical application.
Objective To study the application effect of sevoflurane combined with lidocaine in anesthesia induction intubation. Methods A total of 90 patients who underwent lower abdomen operation in the 254 thHospital of Chinese People's Liberation Army from October 2015 to October 2017 were selected as research subjects. According to the random number table, the patients were divided into an observation group and a control group, with 45 cases in each group. The control group was given anesthetic induction with sevoflurane inhalation, and the observation group was combined with lidocaine for anesthesia induction on the basis of the control group. The changes of mean arterial pressure(MAP), heart rate(HR), peripheral vascular resistance(SVR), stroke volume(SV), cardiac output(CO), peak velocity(VpK) and percentage of ejection time(ET) at static period were compared between the two groups before induction,immediately after intubation, at 1 min and 5 min after intubation. The incidence of postoperative agitation and cough during extubation was also compared between the two groups. Results Compared with before induction, the MAP and HR of the two groups were all reduced at the time of immediately after intubation, and at 1 min and 5 min after intubation; the MAP and HR of the observation group were all higher than those of the control group immediately after intubation, and at 1 min and 5 min after intubation; the differences were statistically significant(P<0.05). Compared with before induction, the SVR, SV, CO and VpK of the two groups were all reduced at the time of immediately after intubation, at 1 min and 5 min after intubation, and the ET increased significantly; the SVR, SV, CO and VpK of the observation group were significantly higher than those of the control group immediately after intubation, at 1 min and5 min after intubation, and the ET was significantly lower than that of the control group; all differences were statistically significant(P<0.05). The incidence of postoperative agitation and cough during extubation in the observation group were 4.44% and 15.56%, respectively, which were significantly lower than those of the control group(22.22% and37.50%, respectively); both differences were statistically significant(P<0.05). Conclusion Sevoflurane combined with lidocaine is effective in anesthesia induction intubation, which has less influence on hemodynamics and cardiac function, and can reduce the incidence of agitation and cough during extubation, with high safety. It is worthy of clinical application.
引文
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[11]曾宪伟.不同浓度七氟烷处理对心肌梗死史全麻手术患者凝血功能、心功能及心率的影响[J].血栓与止血学,2017,23(5):818-819,822.
[12]Liu J,Yang L,Lin D,et al.Sevoflurane blocks the induction of long-term potentiation when present during,but not when present only before,the high-frequency stimulation[J].Anesthesiology,2018,128(3):555-563.
[13]Jalali A,Nasiri E,Khoramian M,et al.Hemodynamic responses to tracheal intubation in elderly patients:intravenous or spray of lidocaine versus fentanyl[J].Med Arch,2017,71(6):424-429.
[14]Rajan S,Arora V,Tosh P,et al.Effectiveness of transtracheal lidocaine as an adjunct to general anesthesia in providing patient immobility during total parotidectomy:a comparison with dexmedetomidine infusion[J].J Anaesthesiol Clin Pharmacol,2017,33(2):193-196.
[15]李平,王健,罗林丽,等.七氟烷吸入诱导麻醉的研究进展[J].华西医学,2017,32(7):1112-1115.
[16]Queiroz-Williams P,Doherty TJ,da Cunha AF,et al.Effects of ketamine and lidocaine in combination on the sevoflurane minimum alveolar concentration in alpacas[J].Can J Vet Res,2016,80(2):141-145.
[17]朱彬,曹晓霞,何永冠,等.七氟烷联合利多卡因对全身麻醉患者心功能影响研究[J].现代生物医学进展,2015,15(12):2278-2280.
[18]Aigbedia SO,Tobi KU,Amadasun FE.A comparative study of ketamine gargle and lidocaine jelly application for the prevention of postoperative throat pain following general anaesthesia with endotracheal intubation[J].Niger J Clin Pract,2017,20(6):677-668.
[2]殷悦,王立伟,祖翠华.不同麻醉药物在气道表面麻醉时对气管插管及拔管反应的影响分析[J].北华大学学报(自然科学版),201718(3):360-364.
[3]Sonkaj?rvi E,Rytky S,Alahuhta S,et al.Epileptiform and periodic EEG activities induced by rapid sevoflurane anaesthesia induction[J].Clin Neurophysiol,2018,129(3):638-645.
[4]Hasan AK,Sivasankar R,Nair SG,et al.Optimum time for intravenous cannulation after induction with sevoflurane,oxygen,and nitrous oxide in children without any premedication[J].Paediatr Anaesth,2018,28(2):179-183.
[5]Jendoubi A,Naceur IB,Bouzouita A,et al.A comparison between intravenous lidocaine and ketamine on acute and chronic pain after open nephrectomy:a prospective,double-blind,randomized,placebo-controlled study[J].Saudi J Anaesth,2017,11(2):177-184.
[6]孙文琴,周爱国,潘道波,等.诱导药顺序对气管插管反应及麻醉深度的影响[J].广东医学,2016,37(20):3124-3126.
[7]Higuchi H,Maeda S,Ishii-Maruhama M,et al.Intellectual disability is a risk factor for delayed emergence from total intravenous anaesthesia[J].J Intellect Disabil Res,2018,62(3):217-224.
[8]熊虹飞,刘鸿涛,田妍静,等.七氟烷不同吸入深度在小儿全麻诱导中的应用[J].山西医科大学学报,2015,46(4):375-378.
[9]Sharma P,Gombar S,Ahuja V,et al.Sevoflurane sparing effect of dexmedetomidine in patients undergoing laparoscopic cholecystectomy:a randomized controlled trial[J].J Anaesthesiol Clin Pharmacol,2017,33(4):496-502.
[10]Kurhekar P,Vinod K,Krishna JSD,et al.Randomized comparison of isoflurane versus sevoflurane and desflurane for maintenance of ambulatory anesthesia[J].Anesth Essays Res,2017,11(4):875-880.
[11]曾宪伟.不同浓度七氟烷处理对心肌梗死史全麻手术患者凝血功能、心功能及心率的影响[J].血栓与止血学,2017,23(5):818-819,822.
[12]Liu J,Yang L,Lin D,et al.Sevoflurane blocks the induction of long-term potentiation when present during,but not when present only before,the high-frequency stimulation[J].Anesthesiology,2018,128(3):555-563.
[13]Jalali A,Nasiri E,Khoramian M,et al.Hemodynamic responses to tracheal intubation in elderly patients:intravenous or spray of lidocaine versus fentanyl[J].Med Arch,2017,71(6):424-429.
[14]Rajan S,Arora V,Tosh P,et al.Effectiveness of transtracheal lidocaine as an adjunct to general anesthesia in providing patient immobility during total parotidectomy:a comparison with dexmedetomidine infusion[J].J Anaesthesiol Clin Pharmacol,2017,33(2):193-196.
[15]李平,王健,罗林丽,等.七氟烷吸入诱导麻醉的研究进展[J].华西医学,2017,32(7):1112-1115.
[16]Queiroz-Williams P,Doherty TJ,da Cunha AF,et al.Effects of ketamine and lidocaine in combination on the sevoflurane minimum alveolar concentration in alpacas[J].Can J Vet Res,2016,80(2):141-145.
[17]朱彬,曹晓霞,何永冠,等.七氟烷联合利多卡因对全身麻醉患者心功能影响研究[J].现代生物医学进展,2015,15(12):2278-2280.
[18]Aigbedia SO,Tobi KU,Amadasun FE.A comparative study of ketamine gargle and lidocaine jelly application for the prevention of postoperative throat pain following general anaesthesia with endotracheal intubation[J].Niger J Clin Pract,2017,20(6):677-668.