【摘要】目的 探讨双腔支气管插管前声门及声门下喷洒利多卡因联合地塞米松气道表面麻醉对双腔支气管插管术后气道并发症的影响。方法 选取胸腔镜肺叶切除术患者90例，随机分为三组： C 组（生理盐水3ml）、L1 组（2% 利多卡因3 ml）和L2 组（2% 利多卡因3 ml+地塞米松5 mg），每组30例。诱导后应用喉麻管行声门及声门下气道内表面麻醉。记录手术时长，插管前（T0），插管时（T1），插管后5 min（T2）、插管后10 min（T3）、及拔管时患者心率（heart rate, HR）、平均动脉压（mean arterial pressure, MAP）；采用视觉模拟评分（visual analogue scale, VAS）评估患者拔管即刻、拔管后6 h、24 h咽喉痛、咽喉部非疼痛性不适的程度。结果 在T1、T2和T3时间点及拔管时，L1组HR（69.2±9.7）次/分、（67.8±5.0）次/分、（64.6±6.7）次/分、（87.1±4.6）次/分和L2组HR（65.6±7.9）次/分、（62.0±8.6）次/分、（60.9±7.6）次/分、（69.0±4.6）次/分低于C组（91.2±6.5）次/分、（92.3±6.7）次/分、（89.3±7.0）次/分、（98.9±5.2）次/分（P均<0.05），L1组MAP（89.9±5.6）mmHg、（90.2±6.9）mmHg、（83.4±7.8）mmHg、（118.3±6.3）mmHg 和L2组MAP（86.4±5.4）mmHg、（87.9±9.9）mmHg、（89.7±7.8）mmHg、（86.9±3.9）mmHg低于C组（104.0±7.9）mmHg、（101.0±6.8）mmHg、（105.0±7.3）mmHg、（118.3±6.3）mmHg（P均<0.05），且L2组低于L1组（P<0.05）；在拔管即刻、术后6 h、24 h，L1组和L2组患者总体VAS 评分、咽喉部非疼痛性不适的程度低于C组（P均<0.05），且L2组低于L1组（P<0.05）。结论 双腔支气管插管前喷洒利多卡因可减轻气管插管反应，使拔管过程更平稳，降低咽喉痛及咽喉部非疼痛性不适的程度，地塞米松可以增强并且延长利多卡因的作用。

【Abstract】Objective To investigate the effect of airway surface anesthesia with lidocaine and dexamethasone on the postoperative airway complications after the double lumen endobronchial intubation before and under the glottis. Methods Ninety patients with thoracoscopic lobectomy were randomly divided into three groups: group C（normal saline 3 ml）, group L1（2% lidocaine 3 ml） and group L2（2% lidocaine 3 ml and dexamethasone 5 mg）, with 30 cases in each group. After induction, laryngeal anesthesia was used to perform glottic and subglottic airway surface anesthesia. The operative duration, pre-intubation (T0), intubation (T1), 5 min after intubation (T2), 10 min after intubation (T3), and the patient's heart rate (HR) and mean arterial pressure (MAP) were recorded. The visual analogue scale (VAS) was used to evaluate the degree of sore throat and non-painful discomfort in the throat immediately after extubation, 6 h and 24 h after extubation. Results At time points T1, T2 and T3 and immediately after extubation, the HR of group L1 (69.2±9.7) times/min, (67.8±5.0) times/min, (64.6±6.7) times/min, (87.1±4.6) times/min and group L2 (65.6±7.9) times/min, (62.0±8.6) times/min, (60.9±7.6) times/min, (69.0±4.6) times/min lower than the HR of group C (91.2±6.5) times/min, (92.3±6.7) times/min, (89.3±7.0) times/min, (98.9±5.2) times/min (all P <0.05), the MAP of group L1 was (89.9±5.6) mmHg, (90.2±6.9) mmHg, (83.4±7.8) mmHg, (118.3±6.3) mmHg and group L2 (86.4±5.4) mmHg, (87.9±9.9) mmHg, (89.7±7.8) mmHg, (86.9±3.9) mmHg were lower than the MAP of group C (104.0±7.9) mmHg, (101.0±6.8) mmHg, (105.0±7.3) mmHg, (118.3±6.3) mmHg (all P<0.05), and both the HR and MAP of the group L2 was lower than group L1 (all P<0.05). Immediately after extubation, 6 h and 24 h after surgery, the overall VAS score and the degree of throat non-painful discomfort in group L1 and L2 were lower than those in group C (all P<0.05), and group L2 was lower than L1 group (all P<0.05). Conclusion Airway surface anesthesia with lidocaine before double lumen endobronchial intubation can relieve endotracheal intubation reaction, make extubation process more stable, reduce the degree of sore throat and non-painful discomfort in the throat. Dexamethasone can enhance and prolong the effect of lidocaine.

南京医科大学校级,NMUB20210228