摘要
目的观察复方利多卡因乳膏应用于心脏手术全麻气管插管时对血流动力学的影响。方法选择美国麻醉医师协会病情分级Ⅱ~Ⅲ级择期行心脏手术者80例,按气管插管导管前端用药的不同,随机分为空白对照组、液状石蜡组、复方利多卡因乳膏组和混合处理组（使用复方利多卡因乳膏及液状石蜡混合剂）,每组20例。予咪达唑仑、顺式苯阿曲库胺、依托咪酯、芬太尼诱导麻醉,后行气管内插管,分别记录诱导前（T0）、意识消失（T1）、插管即刻（T2）及插管后1 min（T3）、3 min（T4）、5 min（T5）和10 min（T6）时患者的平均动脉压（MAP）、心率、心输出量（CO）和心脏指数（CI）。结果 4组T0时间点MAP、心率、CO及CI比较差异无统计学意义（P〉0.05）;与T0时间点比较,4组在T1时间点MAP、心率、CO及CI均降低,但差异无统计学意义（P〉0.05）,4组间比较差异亦无统计学意义（P〉0.05）。空白对照组、液状石蜡组在T2、T3和T4时间点心率、MAP、CO和CI较T0、T1、T5、T6时间点显著增高,差异有统计学意义（P〈0.05,P〈0.01）,尤以T3时间点变化最显著（P〈0.01）;复方利多卡因乳膏组和混合处理组各时间点MAP、心率、CO及CI组内和组间比较差异无统计学意义（P〉0.05）;复方利多卡因乳膏组、混合处理组在T2、T3和T4时间点各指标较空白对照组、液状石蜡组显著降低,差异有统计学意义（P〈0.05）。结论复方利多卡因乳膏可有效抑制心脏手术气管插管应激反应,维护麻醉诱导期间血流动力学的稳定。
Objective To investigate the influence of compound lidocain cream on hemodynamics in cardiac surgery during endotracheal intubation.Methods 80 patients of grade Ⅱ~Ⅲ of the American Society of Anesthesiologists scheduled for cardiac surgery were selected and randomly divided into 4 groups with 20 patients in each group according to what the endotracheal tube smeared;they were control group,liquid paraffin group,compound lidocain cream group and mixture group（the endotracheal tube was smeared with mixture of liquid paraffin and compound lidocain cream）.Anesthesia was induced with midazolam,cisatracurium,etomidate and fentanyl.MAP,HR,CO and CI were observed on T0（pre-induction）,T1（unconscionsness）,T2（intubating）,T3（1 min after intubating）,T4（3 min after intubating）,T5（5 min after intubating） and T6（10 min after intubating）.Results The hemodynamic indexes were no significant difference on T0 in all 4 groups（P0.05）;compared with T0,MAP,CO,HR and CI increased on T1 with no significant difference in all of groups（P0.05）,and there was no significant difference in each group（P0.05）.When compared with T0,T1,T5 and T6,the MAP,HR,CO and CI in control group and liquid paraffin group showed obvious increase on T2,T3 and T4（P0.05,P0.01）,especially on T3（P0.01）.The difference between compound lidocain cream group and mixture group was not statistically significant（P0.05）,but all the indicators on T2,T3,and T4 in the two groups were lower than that in the other two groups,and the difference was statistically significant（P0.05）.Conclusion Compound Lidocaine cream can inhibit the stress response of endotracheal intubation in cardiac surgery to maintain hemodynamic stability during general anesthesia.
出处
《临床误诊误治》
2010年第12期1126-1128,共3页
Clinical Misdiagnosis & Mistherapy
关键词
利多卡因
心脏外科手术
插管法
气管内
血流动力学
Lidocaine
Cardiac surgical procedures
Intubation
intratracheal
Hemodynamics
