利多卡因经气管内给药和静脉给药对全麻苏醒期患者镇静镇痛效果、血流动力学和呛咳反应的影响

摘要 目的：探讨利多卡因经气管内给药和静脉给药对全麻苏醒期患者镇静镇痛效果、血流动力学和呛咳反应的影响。方法：选取2018年3月~2019年8月于我院在气管内全麻下完成泌尿外科、腹部外科并预计于术后可以迅速拔除气管导管的患者63例，上述患者根据随机数字表法分为A组（n=31）和B组（n=32），A组患者给予利多卡因静脉给药，B组患者给予利多卡因经气管内给药，比较两组患者苏醒时间、拔管时间、镇静镇痛效果、血流动力学及呛咳反应。结果：两组苏醒时间、拔管时间组间比较差异无统计学意义（P>0.05）。两组插管时、拔管时、拔管后10 min心率（HR）、收缩压（SBP）、舒张压（DBP）均呈先升高后降低趋势，且B组插管时、拔管时、拔管后10 min的HR、SBP、DBP均低于A组（P<0.05）。两组拔管时、拔管后10 min组内及组间镇静-躁动评分(SAS)比较差异无统计学意义（P>0.05）；两组拔管后10 min疼痛视觉模拟量表(VAS)评分高于拔管时，但B组低于A组（P<0.05）。B组患者插管时、拔管时呛咳反应发生率均低于A组（P<0.05）。结论：与静脉给药相比，全麻苏醒期患者给予利多卡因经气管内给药，镇静镇痛效果确切，可减轻血流波动，降低插管时、拔管时呛咳反应发生率。

Effects of Lidocaine on Sedation, Analgesia, Hemodynamics and Cough Response in Patients Undergoing General Anesthesia

ABSTRACT Objective: To investigate the effects of lidocaine on sedation and analgesia, hemodynamics and cough response in patients with general anesthesia during the recovery period. Methods: From March 2018 to August 2019, 63 patients who had completed urology and abdominal surgery under endotracheal general anesthesia in our hospital and were expected to have tracheal catheters removed quickly after surgery were selected The above patients were divided into group A (n = 31) and group B (n = 32) according to the random number table. Group A patients were given lidocaine intravenously, and group B patients were given lidocaine intratracheal. The recovery time, extubation time, sedation and analgesia effect, hemodynamics and cough response of the two groups were compared. Results: There were no significant difference in recovery time and extubation time between the two groups (P>0.05). Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) increased first and then decreased in the two groups during intubation, extubation and 10 minutes after extubation, and HR, SBP and DBP in group B at during intubation, extubation and 10 minutes after extubation were lower than those in group A (P<0.05). There was no significant difference in Sedation agitation score (SAS) between the two groups at the time of extubation and 10 minutes after extubation (P>0.05). Visual analogue scale (VAS) score of pain 10 min after extubation was higher than that of extubation in the two groups, but that in group B was lower than that in group A (P<0.05). The incidence of cough reaction during intubation and extubation in group B during intubation, extubation were lower than those in group A (P<0.05). Conclusion: Compared with intravenous administration, the administration of lidocaine in the wake period of general anesthesia has a definite sedative and analgesic effect, which can reduce the fluctuation of blood flow and reduce the incidence of choking reaction during intubation and extubation.