金喉健喷雾剂和利多卡因气雾剂在全身麻醉气管插管中的应用比较

doi:10.3969/j.issn.1674-8115.2022.01.013

摘要/Abstract

摘要：

目的·比较金喉健喷雾剂和利多卡因气雾剂在全身麻醉气管插管中的临床应用效果。方法·纳入上海交通大学医学院附属瑞金医院100例择期行腹腔镜胆囊切除术的全身麻醉气管插管的患者，按随机数字表分为金喉健喷雾剂组（研究组）和利多卡因气雾剂组（对照组），每组50例。麻醉诱导后l min，在UE可视喉镜暴露声门后，将金喉健喷雾剂或利多卡因气雾剂于咽喉部分别按2揿。观察插管前（T0）、插管即刻（T1）、插管后3 min（T2）、插管后5 min（T3）、插管后10 min（T4）、拔管即刻（T5）、拔管后3 min（T6）和拔管后5 min（T7）的平均动脉压（mean arterial pressure， MAP）和心率（heart rate， HR）变化。记录患者拔管前后苏醒期躁动评分和对气管导管的耐受度。术后24 h进行随访，观察患者咽喉疼痛、声音嘶哑及拔管反应等情况。结果·2组患者一般情况具有可比性。2组患者经药物处理后，都能预防气管插管和拔管引起的心血管应激反应，MAP、HR、苏醒期躁动评分比较，差异均无统计学意义。与对照组相比，研究组对气管导管的耐受满意度（P=0.021）和可接受度（P=0.021）明显提高，且术后24 h内咽痛发生率显著减低（P=0.020）。结论·应用金喉健喷雾剂能有效降低全身麻醉气管插管引起的心血管应激反应，提高行腹腔镜胆囊切除术患者对气管导管的耐受度，减轻术后咽痛发生率。

关键词: 金喉健喷雾剂, 利多卡因, 气管插管, 血流动力学, 咽痛

Abstract:

Objective·To compare the clinical application of Jinhoujian spray and Lishuka aerosol (lidocaine) in tracheal intubation under general anesthesia.

Methods·A total of 100 patients undergoing elective laparoscopic cholecystectomy with tracheal intubation under general anesthesia were enrolled in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. They were randomly divided into Jinhoujian spray group (research group) and lidocaine aerosol group (control group), with 50 patients each. 1 min after anesthesia induction, the glottis was exposed by UE visual laryngoscope and Jinhoujian spray or lidocaine aerosol was applied to the throat by 2 press respectively. Mean arterial pressure (MAP) and heart rate (HR) were recorded at different time points, including before anesthesia induction (T0) , the time (T1),3 min (T2), 5 min (T3) and 10 min (T4) after intubation of endotracheal tube, the time (T5), 3 min (T6) and 5 min (T7) after extubation of endotracheal tube. MAP and HR were observed at different time points, including before (T0) and immediately after intubation (T1), 3 min (T2), 5 min (T3) and 10 min after intubation (T4), immediately (T5), 3 min (T6) and 5 min after extubation (T7). The emergence agitation and acceptance of tracheal tube were also recorded before and after extubation. The patients were followed up 24 h after the operation to observe pharyngalgia, hoarseness and extubation responses.

Results·There was no significant difference in general features between the two groups. After drug treatment, both groups could prevent the cardiovascular stress response caused by endotracheal intubation and extubation. And there was no statistical significance in MAP, HR and emergence agitation scores. Compared with the control group, the tolerance satisfaction of tracheal catheter (P=0.021) and acceptability (P=0.021) were significantly improved in the research group, and the incidence of pharyngeal pain within 24 h after surgery was significantly reduced (P=0.020).

Conclusion·The application of Jinhoujian spray can effectively reduce the cardiovascular stress response caused by tracheal intubation under general anesthesia, improve the tolerance of patients undergoing laparoscopic cholecystectomy to tracheal catheter, and reduce the incidence of postoperative pharyngeal pain.

Key words: Jinhoujian aerosol, lidocaine, tracheal intubation, haemodynamics, pharyngalgia

中图分类号:

R614.2

吴雷, 杜重临, 夏一梦. 金喉健喷雾剂和利多卡因气雾剂在全身麻醉气管插管中的应用比较[J]. 上海交通大学学报(医学版), 2022, 42(1): 90-94.

Lei WU, Chonglin DU, Yimeng XIA. Clinical comparison on patients undergoing general anesthesia and tracheal intubation between Jinhoujian and lidocaine aerosol[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2022, 42(1): 90-94.

图/表 4

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Indicator	Research group （n=50）	Control group （n=50）	P value
Age/year	47.92±12.86	48.74±13.84	0.777
Gender（male/female）/n	22/28	23/27	0.791
ASA classification （Ⅰ/Ⅱ/Ⅲ）/n	45/5/0	43/7/0	0.643
BMI/（kg·m^-2）	24.06±5.07	23.60±4.96	0.548
Anesthesia duration/min	131.1±61.88	114.40±57.16	0.081
Operation duration/min	105.60±59.33	92.70±60.17	0.142
Total fluid/mL	1 410.00±227.48	1 029.03±477.18	0.126
Mallampati classification （Ⅰ/Ⅱ/Ⅲ/Ⅳ）/n	38/10/2/0	42/8/0/0	0.723

Indicator	Research group （n=50）	Control group （n=50）	P value
Age/year	47.92±12.86	48.74±13.84	0.777
Gender（male/female）/n	22/28	23/27	0.791
ASA classification （Ⅰ/Ⅱ/Ⅲ）/n	45/5/0	43/7/0	0.643
BMI/（kg·m^-2）	24.06±5.07	23.60±4.96	0.548
Anesthesia duration/min	131.1±61.88	114.40±57.16	0.081
Operation duration/min	105.60±59.33	92.70±60.17	0.142
Total fluid/mL	1 410.00±227.48	1 029.03±477.18	0.126
Mallampati classification （Ⅰ/Ⅱ/Ⅲ/Ⅳ）/n	38/10/2/0	42/8/0/0	0.723

Time	Item	Research group （n=50）	Control group （n=50）	P value
T0	MAP/mmHg	98.54±12.38	97.50±13.28	0.319
	HR/（beat·min^-1）	75.84±14.51	77.56±14.32	0.271
T1	MAP/mmHg	90.52±16.00	88.47±13.41	0.230
	HR/（beat·min^-1）	80.28±14.41	80.32±13.43	0.494
T2	MAP/mmHg	83.69±11.23	86.55±13.98	0.115
	HR/（beat·min^-1）	75.76±13.64	73.38±12.96	0.442
T3	MAP/mmHg	79.36±11.75	80.26±11.08	0.338
	HR/（beat·min^-1）	70.38±12.32	68.28±10.75	0.179
T4	MAP/mmHg	76.09±10.00	78.95±10.92	0.074
	HR/（beat·min^-1）	66.64±10.77	64.36±9.61	0.130
T5	MAP/mmHg	100.11±15.07	97.88±14.55	0.201
	HR/（beat·min^-1）	87.26±14.48	81.24±17.75	0.028
T6	MAP/mmHg	98.37±14.78	97.67±11.82	0.383
	HR/（beat·min^-1）	82.76±12.60	78.36±12.14	0.032
T7	MAP/mmHg	93.71±12.76	96.09±10.67	0.119
	HR/（beat·min^-1）	74.76±11.72	74.30±9.34	0.410

Time	Item	Research group （n=50）	Control group （n=50）	P value
T0	MAP/mmHg	98.54±12.38	97.50±13.28	0.319
	HR/（beat·min^-1）	75.84±14.51	77.56±14.32	0.271
T1	MAP/mmHg	90.52±16.00	88.47±13.41	0.230
	HR/（beat·min^-1）	80.28±14.41	80.32±13.43	0.494
T2	MAP/mmHg	83.69±11.23	86.55±13.98	0.115
	HR/（beat·min^-1）	75.76±13.64	73.38±12.96	0.442
T3	MAP/mmHg	79.36±11.75	80.26±11.08	0.338
	HR/（beat·min^-1）	70.38±12.32	68.28±10.75	0.179
T4	MAP/mmHg	76.09±10.00	78.95±10.92	0.074
	HR/（beat·min^-1）	66.64±10.77	64.36±9.61	0.130
T5	MAP/mmHg	100.11±15.07	97.88±14.55	0.201
	HR/（beat·min^-1）	87.26±14.48	81.24±17.75	0.028
T6	MAP/mmHg	98.37±14.78	97.67±11.82	0.383
	HR/（beat·min^-1）	82.76±12.60	78.36±12.14	0.032
T7	MAP/mmHg	93.71±12.76	96.09±10.67	0.119
	HR/（beat·min^-1）	74.76±11.72	74.30±9.34	0.410

Item	Research group	Control group	P value
Item	（n=50）	（n=50）	P value
Emergence agitation score
0	49 （98.0）	45 （90.0 ）	0.056
1	1 （2.0）	4 （8.0）	0.161
2	0	1 （2.0）	0.314
3	0	0	1.000
Tube resistance
Satisfaction	50 （100.0）	45 （90.0）	0.021
Acceptable	0	5 （10.0）	0.021
Dissatisfaction	0	0	1.000