本文關鍵詞： 麻醉 氣管插管 顱腦手術 應激反應　出處：《吉林大學》2015年碩士論文　論文類型：學位論文

【摘要】：研究背景： 心血管不良反應是全麻插管常見的并發(fā)癥，主要表現為血壓升高，心率曾快。為減少和預防氣管插管及拔管應激反應的發(fā)生，國內外醫(yī)學界多采用加深麻醉，一種或兩種呼吸道粘膜表面麻醉及藥物預防等措施，但是關于三種表面麻醉方法聯(lián)合應用對全麻氣管插管及拔管應激反應的影響的研究尚較少。 目的： 觀察2%利多卡因溶液咽喉黏膜及聲門下噴霧與復方利多卡因乳膏聯(lián)合應用在顱腦手術中抑制氣管插管及拔管應激反應的效果。 方法： 擇期進行開顱手術的患者90例（ASAⅠ或Ⅱ級），隨機分為三組，每組30例。A組患者用2%的利多卡因溶液2ml行咽喉黏膜噴霧表面麻醉，然后用喉麻管給予生理鹽水2ml聲門下噴霧，在氣管導管前端涂上腔道潤滑劑2g后行氣管插管；B組患者在2%利多卡因2ml咽喉黏膜噴霧表面麻醉后，2%利多卡因2ml通過喉麻管給予聲門下噴霧，氣管導管前端涂腔道潤滑劑2g行氣管插管；C組患者為2%利多卡因2ml咽喉黏膜噴霧表面麻醉，喉麻管給予2%利多卡因2ml聲門下噴霧，于氣管導管前端涂復方利多卡因乳膏2g后行氣管插管。麻醉誘導均采用快誘導，靜脈給予咪達唑侖0.05mg/kg、依托咪酯乳劑0.3mg/kg、芬太尼0.03mg/kg、苯磺順阿曲庫銨0.15mg/kg，待患者睫毛反射消失，面罩控制呼吸給氧去氮4min。達適當肌松后，用加強型氣管導管（ID:女7.0mm，男7.5mm）行氣管插管，接麻醉機行機械通氣，潮氣量8～10ml/kg，維持呼氣末二氧化碳分壓（PETCO2）35～45mmHg。麻醉維持用1%丙泊酚和鹽酸瑞芬太尼，間斷追加苯磺順阿曲庫銨，根據麻醉深度調整麻醉藥用量，維持Narcotrend指數在30～60。術畢停止麻醉藥輸注，深麻醉下吸痰后將患者送入麻醉蘇醒室，待患者自主呼吸恢復、SpO295%、潮氣量5ml/kg，喚之可睜眼時由一名不知分組情況的麻醉醫(yī)師拔除氣管導管并收集資料。記錄插管前（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）各時點患者心率（HR）、收縮壓（SBP）、舒張壓（DBP）的變化，同時采集靜脈血測各時點腎上腺素（AD）、去甲腎上腺素（NE）、血漿皮質醇（CORT）的含量。記錄手術時間、麻醉時間，追蹤并記錄麻醉蘇醒期患者躁動及拔管后24h咽喉疼痛的發(fā)生情況。 結果： C組患者各時點HR、SBP、DBP的變化以及靜脈血AD、NE、CORT的含量均明顯低于A、B兩組（p＜0.05），且蘇醒期躁動及拔管后24h患者咽喉疼痛的發(fā)生率明顯低于A、B兩組（p＜0.05）。 結論： 在顱腦手術中，，三種表麻聯(lián)合應用可有效降低氣管插管反應的發(fā)生，提高患者對氣管導管的耐受性。
[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.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R614.2

【參考文獻】

相關期刊論文 前10條

1 張慧敏;呂瑩;;復方利多卡因乳膏在血液病患兒PICC穿刺中鎮(zhèn)痛效果的觀察[J];護士進修雜志;2010年12期

2 顧軍養(yǎng);王素萍;朱燕君;;復方利多卡因乳膏在小兒橈動脈穿刺中的應用[J];護士進修雜志;2011年02期

3 劉春玉;曾明廣;陳秀梅;梁志文;;復方利多卡因乳膏宮頸管表面麻醉對絕經婦女取環(huán)術鎮(zhèn)痛效應的影響[J];廣東醫(yī)學;2011年24期

4 劉晶晶;朱志兵;;復方利多卡因乳膏用于傷口換藥的方法[J];長江大學學報(自科版);2013年21期

5 蘇藝峰;賈洪峰;呂凌焰;;尼卡地平復合艾司洛爾控制性降壓在鼻內窺鏡手術中的應用[J];航空航天醫(yī)藥;2009年12期

6 陸俊雯,關開華,陳小君,韋旭生,楊彩仙,謝綺明,覃鳳林;恩納霜用于術前靜脈置管鎮(zhèn)痛的臨床觀察[J];現代護理;2005年07期

7 賀偉忠;楊義;劉冬冬;李敏;;復方利多卡因乳膏對高齡患者全身麻醉拔管期心血管反應的影響[J];河南外科學雜志;2010年01期

8 張璐瑤;董鐵立;;復方利多卡因乳膏對雙腔支氣管插管患者拔管應激反應影響[J];中華實用診斷與治療雜志;2011年06期

9 江健;彭弋峰;徐慶陽;賈超;楊本海;;復方利多卡因乳膏聯(lián)合小劑量西地那非治療早泄[J];吉林醫(yī)學;2011年09期

10 盧東雪;成丹丹;熊利澤;陳紹洋;孫焱芫;;表面麻醉減輕嬰幼兒氣管內插管并發(fā)癥的效果[J];臨床麻醉學雜志;2010年06期

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