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目的评价复方利多卡因乳膏涂抹气管导管用于气管黏膜表面麻醉对提高经鼻蝶窦垂体瘤苏醒期拔除气管导管平稳性的有效性。方法本研究为前瞻随机对照研究,连续纳入北京协和医院60例经鼻蝶窦垂体瘤手术的患者,随机分为试验组(L组)和对照组(C组)。将L组气管导管前二分之一和套囊表面均匀涂布复方利多卡因乳膏,C组导管表面涂抹石蜡油。研究终点为苏醒期的呛咳事件。记录围术期血流动力学指标、患者在麻醉恢复室(PACU)的拔管时间,随访住院期间并发症。结果拔管期的自发呛咳率L组低于C组(7%vs.40%,P<0.01);诱发的呛咳率L组显著低于C组(20%vs.60%,P<0.01)。术毕至拔管时间L组小于C组[(18±6)min vs.(27±6)min,P<0.05]。需要追加芬太尼的患者比例L组低于C组(17%vs.70%,P<0.01)。L组的收缩压与心率乘积在拔管时和拔管后1 min均低于C组(P<0.05)。结论对于全麻经鼻蝶窦垂体瘤手术,气管导管表面涂抹复方利多卡因乳膏进行气管黏膜表面麻醉能有效减少苏醒期患者的呛咳事件、减少芬太尼补救用药量、缩短术毕至拔管时间并降低拔管时血流动力学波动。
Objective To evaluate the effectiveness of compound lidocaine cream for tracheal catheter for tracheal mucosal surface anesthesia to improve the transthoracic tracheal stability during transsphenoidal pituitary adenoma revascularization. Methods This prospective prospective randomized controlled study included 60 consecutive patients who underwent transnasal sinus pituitary surgery at Peking Union Medical College Hospital and were randomly divided into experimental group (L group) and control group (C group). The L group of tracheal catheter and the cuff surface of the first half of the compound coated lidocaine cream, C group catheter surface coated with paraffin oil. The end of the study was the choking episode during the recovery phase. The perioperative hemodynamic parameters, extubation time of patients in the PACU, and follow-up complications during hospitalization were recorded. Results The spontaneous cough rate during extubation was lower in group L than in group C (7% vs. 40%, P <0.01). The rate of cough induced in group L was significantly lower than that in group C (20% vs.60%, P < 0.01). The time from operation to extubation in L group was smaller than that in C group [(18 ± 6) min vs. (27 ± 6) min, P <0.05]. The proportion of patients requiring fentanyl supplementation was lower in group L than in group C (17% vs. 70%, P <0.01). The product of systolic pressure and heart rate in group L was lower than that in group C at extubation and 1 min after extubation (P <0.05). Conclusion Anesthesia of tracheal mucosa with compound lidocaine cream on tracheal tube surface can effectively reduce choking events in patients with awakening during anesthesia with transsphenoidal surgery and reduce the dose of fentanyl remedy and shorten the operation Extubation time and decrease hemodynamics during extubation.