摘要
目的探讨丙泊酚联合利多卡因在ICU气管切开术中的镇静效果及对患者应激反应、呼吸抑制和苏醒后疼痛的影响。方法选取2021年1月至2022年12月于我院行气管切开的ICU患者94例,按照信封法随机分为观察组与对照组,每组47例。观察组给予丙泊酚负荷剂量1.5 mg/kg静脉推注,丙泊酚维持量4 mg/(kg·h)泵注,利多卡因0.1 g局部浸润麻醉。对照组给予咪唑安定0.02 mg/kg静脉推注,利多卡因0.1 g局部浸润麻醉。比较2组患者麻醉前(T0)、麻醉完成后(T1)、气管切开时(T2)、术毕5 min(T3)的脑电双频指数(BIS)监测值、血浆皮质醇(Cor)、去甲肾上腺素(NE)、心率、收缩压、舒张压、脉搏血氧饱和度(SpO_(2));比较2组患者T0时及苏醒后30 min、1 h、2 h时的视觉模拟量表(VAS)评分。记录患者不良反应发生情况。结果在T1、T2、T3时间点,观察组BIS监测值均低于对照组(P<0.05),血浆Cor、NE水平均低于对照组(P<0.05),心率、收缩压、舒张压均低于对照组(P<0.05),SpO_(2)高于对照组(P<0.05)。在苏醒后30 min、1 h、2 h,观察组VAS评分低于对照组(P<0.05)。观察组呼吸抑制、呛咳、烦躁等不良反应的总发生率低于对照组,差异有统计学意义(P<0.05)。结论ICU气管切开术中应用丙泊酚联合利多卡因麻醉,镇静镇痛效果满意,可减轻患者应激反应,呼吸抑制风险较低。
Objective To explore the sedative effect of propofol combined with lidocaine during ICU tracheotomy and its influences on stress response,respiratory depression and pain after awakening in patients.Methods A total of 94 patients in ICU who underwent tracheotomy in our hospital from January 2021 to December 2022 were enrolled,and they were randomly divided into the observation group and the control group by envelope method,with 47 cases in each group.The observation group was given intravenous injection of propofol with a loading dose of 1.5 mg/kg,pump injection of propofol with a maintenance dose of 4 mg(/kg·h),and local infiltration anesthesia with 0.1 g lidocaine.While the control group was given intravenous injection of 0.02 mg/kg midazolam and local infiltration anesthesia with 0.1 g lidocaine.The bispectral index(BIS)monitoring values,levels of plasma cortisol(Cor)and norepinephrine(NE),heart rate,systolic blood pressure,diastolic blood pressure and pulse oxygen saturation(SpO_(2))before anesthesia(T0),after anesthesia completion(T1),at tracheotomy(T2)and 5 minutes after surgery(T3)were compared between the two groups.The visual analogue scale(VAS)scores at T0 and 30 minutes,1 hour and 2 hours after awakening were compared between the two groups,and the adverse reactions of patients were recorded.Results At T1,T2 and T3,the BIS monitoring values in the observation group were lower than those in the control group(P<0.05),the levels of plasma Cor and NE were lower than those in the control group(P<0.05),the heart rate,systolic blood pressure and diastolic blood pressure were lower than those in the control group(P<0.05),and the SpO_(2) was higher than that in the control group(P<0.05).At 30 minutes,1 hour and 2 hours after awakening,the VAS scores in the observation group were lower than those in the control group(P<0.05).The total incidence of adverse reactions such as respiratory depression,coughing and irritability in the observation group was lower than that in the control group,with statistically signifi
作者
顾怀金
王建斌
何军
朱哲
GU Huai-jin;WANG Jian-bin;HE Jun;ZHU Zhe(Department of Critical Care Medicine,Huaibei People's Hospital,Huaibei Anhui 235000,China)
出处
《局解手术学杂志》
2023年第9期809-813,共5页
Journal of Regional Anatomy and Operative Surgery
