哮喘联盟

   摘要
   目的：评价利多卡因喷雾于喉部和/或注入气管导管套囊内对减少拔管时咳嗽和术后咽痛的作用。
   方法：120例行择期妇科手术（持续时间<120分钟）的女性被纳入该项随机、双盲、前瞻性研究。气管插管前，将4%利多卡因或0.9%生理盐水喷雾于患者声门上、下区域。气管插管后，在套囊内注入2%碱化利多卡因溶液或0.9%生理盐水。共分为四组：喷雾-套囊组、喷雾-生理盐水组、生理盐水-喷雾组和生理盐水-生理盐水组。采用两因素logistic回归法进行分析。主要结果为气管拔管时的咳嗽发生率，次要结果为气管拔管后15min、60min和24h时的咽喉痛发生率和严重程度。
   结果：喷雾-套囊组、喷雾-生理盐水组、生理盐水-套囊组和生理盐水-生理盐水组患者的咳嗽发生率分别为42%、24%、63%和69%。使用利多卡因喷雾可显著减少拔管时的咳嗽发生(比值比OR = 0.256; 95% CI= 0.118 -0.554; P < 0.001)； 而使用套囊内注入碱化利多卡因对咳嗽的发生无影响(P = 0.471)。各组的咽痛严重程度均较低（视觉模拟评分[VAS] ≤ 3），声嘶、吞咽困难、恶心或呕吐无显著差异。
   结论：对于少于两个小时外科手术，使用利多卡因喷雾可减少气管拔管时咳嗽的发生。高容量/低气压气管套囊内注入碱化利多卡因对减少咳嗽或疼痛的发生无影响。   
 

 (林江涛 审校)
Can J Anaesth. 2013 Apr;60(4):370-376. Epub 2013 Feb 1.

 

The effects of lidocaine spray and intracuff alkalinized lidocaine on the occurrence of cough at extubation: a double-blind randomized controlled trial.
 

D'Aragon F, Beaudet N, Gagnon V, Martin R, Sansoucy Y.
 

Abstract
PURPOSE: Our study aimed to evaluate the effects of lidocaine sprayed onto the larynx and/or injected into the tracheal tube cuff to decrease the incidence of cough at extubation and postoperative sore throat.
METHODS: One hundred twenty women scheduled for gynecological surgery < 120 min in duration were enrolled in this randomized double-blind prospective study. Prior to tracheal intubation, 4% lidocaine or 0.9% saline was sprayed onto the patients' supra- and subglottic areas. After tracheal intubation, the tracheal tube cuff was filled with either an alkalinized 2% lidocaine solution or 0.9% saline. This resulted in four groups: spray-cuff, spray-saline, saline-cuff, and saline-saline. A logistic regression comprising the two factors was used for analysis. The primary outcome was the incidence of cough at extubation. The secondary outcome was the incidence and severity of sore throat reported by patients at 15 min, 60 min, and 24 hr after tracheal extubation.
RESULTS: Cough occurred in 42%, 24%, 63%, and 69% of patients in the spray-cuff, spray-saline, saline-cuff, and saline-saline groups, respectively. The use of lidocaine spray decreased the incidence of cough at extubation (odds ratio = 0.256; 95% confidence interval 0.118 to 0.554; P < 0.001); however, the use of intracuff alkalinized lidocaine had no impact on the occurrence of cough (P = 0.471). Severity of sore throat was clinically low (visual analog scale [VAS] ≤ 3) in all groups. No significant difference was observed in hoarseness, dysphagia, nausea, or vomiting.
CONCLUSION: Sprayed lidocaine decreases the incidence of cough at tracheal extubation in surgeries of less than two hours. The use of alkalinized lidocaine into high-volume/low-pressure endotracheal cuffs had no impact on decreasing the incidence of cough or pain.
 

Can J Anaesth. 2013 Apr;60(4):370-376. Epub 2013 Feb 1.