| 摘要: |
| 目的 探讨利多卡因对口腔颌面手术后留置经鼻气管插管患者舒适度的影响。方法 本研究为随机、单盲、平行对照临床试验设计。选择上海交通大学医学院附属第九人民医院2020年4－6月收治的拟行择期口腔颌面手术的患者106例，随机分为3组，所有患者术后均留置经鼻气管插管至少12 h。利多卡因静脉泵注组35例，手术结束转入外科重症监护室（SICU）后静脉推注1.5 mg/kg（20 mg/mL）负荷剂量利多卡因，之后以1.5 mg·kg－1·h－1 （使用生理盐水稀释至10 mg/mL）持续泵注12 h；利多卡因表面麻醉组35例，手术结束转入SICU后每2 h通过人工气道喷注利多卡因气雾剂2次，每次间隔2 min，每次2喷；对照组36例，手术结束转入SICU后静脉推注0.075mL/kg负荷剂量生理盐水，之后以0.15 mL·kg－1·h－1持续泵注12 h。转入SICU后每小时记录1次患者的收缩压、舒张压、平均动脉压、心率、呼吸频率、切口疼痛视觉模拟量表（VAS）评分、咽喉疼痛VAS评分，以及每小时内恶心呕吐及呛咳的发生频次。结果 利多卡因静脉泵注组和表面麻醉组患者转入SICU的收缩压、舒张压、平均动脉压、心率与对照组相比差异均无统计学意义（P均>0.05），呼吸频率均降低（P均<0.05）。与对照组相比，利多卡因静脉泵注组和表面麻醉组患者的舒适性指标咽喉疼痛VAS评分均降低（P均<0.05），恶心呕吐及呛咳发生频次均减少（P均<0.05）；利多卡因静脉泵注组患者的切口疼痛VAS评分也降低（P<0.05），而利多卡因表面麻醉组切口疼痛VAS评分与对照组相比差异无统计学意义（P>0.05）。与利多卡因表面麻醉组相比，利多卡因静脉泵注组切口疼痛及咽喉疼痛VAS评分均更低（P均<0.05），呛咳发生频次更少（P<0.05）。在手术结束转入SICU后1～12 h，利多卡因静脉泵注组患者的收缩压、舒张压、平均动脉压逐渐降低，恶心呕吐及呛咳发生频次逐渐减少（P均<0.05）；利多卡因表面麻醉组收缩压、平均动脉压逐渐降低，恶心呕吐及呛咳发生频次逐渐减少（P均<0.05）；对照组仅恶心呕吐及呛咳发生频次逐渐减少（P均<0.05）。结论 利多卡因静脉泵注及气道内表面麻醉能提高口腔颌面手术后留置经鼻气管插管患者的舒适性，且无严重不良反应，其中以静脉泵注的干预效果更佳。 |
| 关键词: 利多卡因 经鼻气管插管 患者舒适度 口腔颌面外科学 |
| DOI：10.16781/j.0258-879x.2021.06.0633 |
| 投稿时间：2020-08-31修订日期：2021-03-12 |
| 基金项目: |
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| Lidocaine improves comfort of patients with transnasal endotracheal intubation after oral and maxillofacial surgery: a randomized, single-blind, parallel controlled clinical trial |
| SUN Lu-lu,XU Zhi-xia,YANG Yue-lai,CHEN Zhi-feng,XIA Ming,HUANG Yan* |
(Surgical Intensive Care Unit, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
*Corresponding author) |
| Abstract: |
| Objective To investigate the effect of lidocaine on the comfort of patients with transnasal endotracheal intubation after oral and maxillofacial surgery. Methods This is a randomized, single-blind, parallel controlled clinical trial. A total of 106 patients undergoing elective oral and maxillofacial surgery in the Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine from Apr. to Jun. 2020 were selected and randomly divided into 3 groups (transnasal endotracheal intubation was indwelled for more than 12 h after surgery in all patients): lidocaine pumping group (35 cases, injected intravenously with 1.5 mg/kg [20 mg/mL] loading dose of lidocaine in surgical intensive care unit [SICU] after operation, and then pumped with 1.5 mg·kg－1·h－1 [diluted to 10 mg/mL with normal saline] for 12 h), lidocaine spray group (35 cases, lidocaine aerosol sprayed twice every 2 h through artificial airway with an interval of 2 min and 2 sprays each time in SICU after operation) and control group (36 cases, injected with 0.075 mL/kg loading dose of normal saline intravenously in SICU after operation, and then pumped with 0.15 mL·kg－1·h－1 infusion continued to 12 h). The systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), visual analogue scale (VAS) score of incision pain, VAS score of postoperative sore throat, and frequencies of nausea/vomiting and cough were recorded every hour in SICU. Results Compared with the control group, no significant differences were observed in the SBP, DBP, MAP or HR in the lidocaine pumping group and lidocaine spray group (all P>0.05). However, the RR of the patients in both groups were lower than that in the control group (both P<0.05). As for comfort signs, lower VAS scores of postoperative sore throat and lower frequencies of nausea/vomiting and cough were recorded in the lidocaine pumping group and lidocaine spray group (all P<0.05); the VAS scores of incision pain were decreased in the lidocaine pumping group (P<0.05), but were similar in the lidocaine spray group and control group (P>0.05). Patients in the lidocaine pumping group had lower VAS scores of incision pain and postoperative sore throat and lower frequency of cough than patients in the lidocaine spray group (all P<0.05). The SBP, MAP and the frequencies of nausea/vomiting and cough in the patients of both treating groups were decreased during 1-12 h in SICU (all P<0.05), and the DBP was also decreased in the lidocaine pumping group (P<0.05). Only frequencies of nausea/vomiting and cough were decreased in the control group (both P<0.05). Conclusion Lidocaine intravenous and surface anesthesia can improve the comfort of patients with transnasal endotracheal intubation after oral and maxillofacial surgery, without causing serious adverse reactions. Furthermore, intravenous injection way is more effective. |
| Key words: lidocaine nasotracheal intubation patient comfort oral and maxillofacial surgery |
