国际麻醉学与复苏杂志   2019, Issue (9): 0-0
    
注药型气管导管联合经皮穴位电刺激对插管期血流动力学影响
王立红, 傅润乔, 康娜, 岳云, 吴安石1()
1.清华大学附属垂杨柳医院
The effect of endotracheal tube with injecting medicine to endotracheal and laryngopharynx for topical anesthesia combined with transcutaneous electrical acupoint stimulation on the hemodynamics of the intubation period
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摘要:

目的 探讨注药型气管导管表面麻醉联合经皮穴位电刺激(transcutaneous electrical acupoint stimulation, TEAS) 对气管插管期血流动力学的影响。 方法 100例ASA分级Ⅰ、Ⅱ级全身麻醉腹腔镜胆囊切除术患者,按随机数字表法分为普通气管导管组(A组)、注药型导管组(B组)、 TEAS+普通气管导管组(C组)和TEAS+注药型导管组(D组),每组25例。分别记录入室平静后(T0)、插管前即刻(T1)、插管后即刻(T2)、插管后3 min(T3)、插管后5 min(T4)、插管后10 min(T5)的SBP、 DBP、 MAP、心率、心指数(cardiac index, CI)、外周血管阻力指数(systemic vascular resistance index, SVRI)和BIS值。 结果 ① SBP:4组在T1时均比T0时明显降低(P<0.05);与T1时比较,T2~T4 时,A组分别升高26%、36%和34%(P<0.01),B组分别升高28%、20%(P<0.01)和9%(P<0.05),C组分别升高25%、27%和21%(P<0.01),D组分别升高16%、16%(P<0.01)和9%(P<0.05)。T3和T4时,与A组比较,B组分别降低12%(P<0.05)和19%(P<0.01),C组分别降低9%(P<0.05)和12%(P<0.01),D组分别降低14%(P<0.01)和19%(P<0.01);T2时,D组比A组、B组、C组降低8%、8%和4%(P<0.05);T4时,D组比C组降低7%(P<0.05)。DBP、MAP变化趋势与SBP相似。② 心率:与T0时比较,4组在T1时均下降(P<0.05);与T1时比较,T2~T4时,A组分别升高30%、49%和44%(P<0.01),B组分别升高36%、21%和11%(P<0.01),C组分别升高19%、35%(P<0.01)和17%(P<0.05),D组分别升高14%、17%(P<0.01)和9%(P<0.05)。③ CI:与T0时比较,各组T1时均下降(P<0.01),T2时A组、B组、C组、D组分别升高18%(P<0.01)、8%、8%(P<0.05)和6%(P<0.05),T3时B组、C组、D组接近于T0,但A组仍升高15%(P<0.01);T0、T1时各组间差异无统计学意义(P>0.05),T2、T3时D组较A组分别降低13%和12%(P<0.05)。④ SVRI:与T0时比较,各组T1时均下降(P<0.05);与T1时比较, C组T3时升高27%(P<0.01),D组T2、T3时分别升高15%和12%(P<0.05)。与A组比较,D组在T2、T3时分别降低14%和10%(P<0.05)。⑤ BIS:与T0时比较,4组T1~T5时均降低,差异有统计学意义(P<0.01)。4组间各个时点差异均无统计学意义(P>0.05)。 结论 注药型气管导管实施气管内-咽喉表面麻醉和TEAS都能在一定程度上抑制插管期高循环动力学反应,二者联合使用效果更好。

关键词: 气管插管; 注药型气管导管; 表面麻醉; 穴位; 经皮电刺激; 血流动力学
Abstract:

Objective To observe the effects of endotracheal tube with injecting medicine to endotracheal and laryngopharynx for topical anesthesia, transcutaneous electrical acupoint stimulation (TEAS), and endotracheal-laryngopharynx for topical anesthesia combined with TEAS on hemodynamics during intubation. Methods One hundred patients that belonged to American Society of Anesthesiologists (ASA) grade Ⅰ or Ⅱ, in accordance with the random number table, were categorized into four groups (n=25). They were endotracheal tube (group A), endotracheal tube with injecting medicine to endotracheal and laryngopharynx (group B), TEAS combined with endotracheal tube (group C) and endotracheal tube with injecting medicine to endotracheal and laryngopharynx combined with TEAS (group D). All patients were monitored continuously on systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), systemic vascular resistance index (SVRI) and bispectral index (BIS) respectively in the calm state at timepoints of entering the operation room (T0), before tracheal intubation after intravenous induce anesthetics (T1), immediately after tracheal intubation (T2), 3 min after tracheal intubation (T3), 5 min after tracheal intubation (T4) and 10 min after tracheal intubation (T5). Results ① Compare with timepoint T0, SBP was decreased markedly (P<0.05) at T1 in each group. At T2, T3 and T4, SBPs were increased 26%, 36% and 34% (P<0.01) in group A. SBPs were increased 28% (P<0.01), 20% (P<0.01) and 9% (P<0.05) in group B. SBPs were increased 25%, 27% and 21% (P<0.01) in group C. SBPs were increased 16% (P<0.01), 16% (P<0.01) and 9% (P<0.05) than T1 respectively. Among groups at same time, SBPs at T3 and T4 were decreased 12% (P<0.05) and 19% (P<0.01) in group B, were decreased 9% (P<0.05) and 12% (P<0.01) in group C, were decreased 14% (P<0.05) and 19% (P<0.01) in group D. At T2, SBP of group D were 8% (P<0.05), 8% (P<0.05) and 4% (P<0.05) lower than the SBP values of group A, B and C respectively. At T4, the value of SBP in group D was 7% lower than the value in group C (P<0.05). ② HR: in all groups, the HR values at T1 (P<0.05) were markedly lower than the values at T0. The HR values of group A at T2, T3 and T4 were 30%, 49% and 44% higher than the value at T1(P<0.01). The HR values of group B were 36%, 21% and 11% higher than the value at T1 (P<0.01). The HR values of group C are 19% (P<0.01), 35% (P<0.01) and 17% (P<0.05) higher than the value at T1. The HR values of group D were 14%, 17% (P<0.01) and 9% (P<0.05) higher than the value at T1. The extent of increasing in group D was smaller than the extents in other groups. ③ CI: in all groups, CI values at T1 were lower than the values at T0 (P<0.01). The values at T2 were 18% (P<0.01), 8%, 8% (P<0.05) and 6% lower than the value at T0. CI values in groupB, C and D at T3 were close to values at T0. But the value at T3 in group A was 15% lower than the value at T0 (P<0.01). There were no significant differences of CI values at T0 and T1 among groups. At T2, T3, CIs in group D were 13% and 12% lower (P<0.05) than A. ④ SVRI: in all groups, SVRI values at T1 were lower than values at T0 (P<0.05). The SVRI value of group C at T3 was 27% higher than the SVRI value at T1 of group C. The SVRI values of group D at T2 and T3 were 15% and 12% (P<0.05) higher than the values at T1 of group D respectivley. CI values of group D at T2 and T3 were 14% and 10% (P<0.05) higher than values in of group A at T2 and T3 respectively. ⑤ BIS: compared with T0, the differences among four groups at T1-T5 were statistically significant (P<0.01). There was no significant differences among four groups at each time point (P>0.05). Conclusions Both endotracheal tube with injecting medicine to endotracheal and laryngopharynx for topical anesthesia and TEAS can reduce excessive hemodynamic responses during the intubation to some extent, but combination of them will has better effect.

Key words: Tracheal intubation; Endotracheal tube with injecting medicine; Topical anesthesia; Acupoints; Transdermal electrostimulation; Hemodynamics