单侧胸椎旁阻滞对实施双腔气管插管患者血流动力学和意识水平的影响

doi:10.19723/j.issn.1671-167X.2024.05.021

摘要/Abstract

摘要：

目的: 观察单侧胸椎旁给予利多卡因椎旁阻滞对双腔气管插管患者血流动力学和意识水平的影响。方法: 选择2021年6月至10月在北京大学国际医院接受经口双腔气管插管全身麻醉下实施择期手术的胸外科患者共40例，患者年龄19~65岁，美国麻醉医师协会(American Society of Anesthesiologists, ASA)Ⅰ~Ⅱ级，随机表法将入选患者分入常规双腔气管插管组(C组，20例)和胸椎旁阻滞给予利多卡因后实施双腔气管插管组(P组，20例)。麻醉诱导后分别采用Macintosh直接喉镜实施经口气管插管操作，观察两组患者麻醉诱导前后，气管插管时，以及气管插管后第1、2、3、4、5分共8个时点的血压(blood pressure, BP)、心率(heart rate, HR)、心率-血压乘积(rate-pressure product，RPP)和脑电双频指数(bispectral index, BIS)的变化，并记录气管插管时间。结果: 麻醉诱导后，两组患者的BP和RPP均较麻醉诱导前基础值明显降低。与麻醉诱导后相比较，气管插管后两组患者的BP、HR和RPP明显升高。与麻醉诱导前相比较，气管插管后C组患者舒张压(diastolic blood pressure, DBP)和平均动脉压(mean arterial pressure, MAP)明显升高，且持续时间约1 min，P组患者收缩压(systolic blood pressure, SBP)无明显增加，DBP在插管后即刻明显增加。与麻醉诱导前比较，两组患者气管插管后HR均明显升高，C组患者HR增快持续约4 min, P组患者HR在插管后即刻明显增加。与C组相比较，观察期内P组气管插管后SBP、DBP、MAP、HR和RPP均明显降低。与基础值相比，两组患者麻醉诱导后和气管插管后观察期间的BIS值均明显降低，且两组间差异无统计学意义。与C组比较，观察期P组SBP大于基础值30%和RPP大于22 000的发生率明显较低，且P组患者中无RPP大于22 000者。在观察期内两组患者SBP小于基础值30%的发生率和HR小于基础值30%的患者比例差异无统计学意义，在整个观察过程中，两组均未发生严重心动过缓。结论: 单侧胸椎旁阻滞在双腔气管插管期间能有效减轻由插管导致的血流动力学变化，且对意识水平无明显影响。

关键词: 插管法，气管内, 利多卡因, 血流动力学, 麻醉，全身, 胸椎旁阻滞

Abstract:

Objective: To compare the effects of unilateral thoracic paravertebal block with lidocaine on hemodynamic and the level of consciousness during double lumen endotracheal intubation. Methods: From June to october 2021, a total of 40 patients American Society of Anesthesiologists (ASA) physical status Ⅰ-Ⅱ, aged 19-65 years, scheduled for elective thoracic sugeries in Peking University International Hospital block with under general anesthesia requiring orotracheal intubation were recruited and divided into two groups: The double-lumen endobronchial intubation (group C) and double-lumen endobronchial intubation after thoracic paravertebal block with lidocaine (group P). After an intravenous anesthetic induction, the orotracheal double-lumen intubation was performed using a Macintosh direct laryngoscopy, respectively. Invasive blood pressure (BP) and heart rate (HR) were recorded before and after anesthetic induction, immediately after intubation and 5 min after intubation with 1-minute interval and the intubation time was also noted. Rate-pressure product (RPP) were calculated. Results: After anesthetic induction, BP and RPP in the two groups decreased significantly compared with their preinduction values. As comparison with their postinduction values, the orotracheal intubation in the two groups caused significant increases in BP, HR and RPP. Diastolic blood pressure (DBP) and mean arterial pressure (MAP) increased significantly and lasted for 1-minute in group C compared with the baseline values. Systolic blood pressure (SBP) was not significant change and DBP increased significantly immediately after intubation in group P.HR of both groups after intubation were significantly higher than their baseline values and lasted for 4 min in group C, HR increased significantly immediately after intubation in group P. SBP, DBP, MAP, HR and RPP after intubation in group P were significantly lower than those of group C during the observation period. The value of BIS was similar between the two groups. Compared with group C, the incidence of SBP greater than 30% and RPP greater than 22 000 was significantly lower in group P in the observation period, and no patient in group P developed RPP greater than 22 000. At the end of the incidence of SBP less than 30% of the basal value and HR less than 30% of the baseline, no severe bradycardia occurred in both groups. Conclusion: During double-lumen endobronchial intubation, unilateral thoracic paravertebal block with lidocaine can provide less hemodynamic response and level of conscionsness.

Key words: Intubation, intratachea, Lidocaine, Hemodynamics, Aesthesia, general, Paravertebral block

中图分类号:

R614

王军, 姚兰, 张宁, 索利斌, 李红培, 魏越, 查鹏, 梁正, 刘鲲鹏. 单侧胸椎旁阻滞对实施双腔气管插管患者血流动力学和意识水平的影响[J]. 北京大学学报（医学版）, 2024, 56(5): 890-895.

Jun WANG, Lan YAO, Ning ZHANG, Libin SUO, Hongpei LI, Yue WEI, Peng CHA, Zheng LIANG, Kunpeng LIU. Effects of unilateral thoracic paravertebal block on hemodynamic and the level of conscionsness during double lumen endotracheal intubation[J]. Journal of Peking University (Health Sciences), 2024, 56(5): 890-895.

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Items	Group C(n＝20)	Group P(n＝20)
Gender，femail/male	5/15	10/10
Age/years，${\bar x}$±s	42.7±16.5	51.6±11.9
Height/cm，${\bar x}$±s	166.8±8.6	165.8±8.4
Weight/kg，${\bar x}$±s	63.0±9.2	62.4±9.7
Type of tube，left/right	12/8	17/3
Model of tube，35/37/39	3/8/9	4/9/7
Intubation time/s，${\bar x}$±s	44.8±16.6	47.9±11.5

Variables	Group	Baseline	Post-ID	Immiedeately	After IT/min					Maximal values
Variables	Group	Baseline	Post-ID	Immiedeately	1	2	3	4	5	Maximal values
SBP/mmHg	C	143±14	96±19^*	155±39^#	161±41^#	138±38^#	126±33^*#	121±28^*#	115±27^*#	181±40^*#
	P	141±11	96±16^*	139±22^#	123±22^*#☆	107±18^*#☆	101±16^*☆	97±16^*☆	95±16^*☆	150±23^#☆
DBP/mmHg	C	74±9	56±11^*	94±25^*#	93±21^*#	83±21^#	77±20^#	74±20^#	72±19^#	111±19^*#
	P	74±9	55±9^*	84±14^#	69±11^#☆	61±9^*#☆	57±8^*☆	56±8^*☆	55±9^*☆	87±15^*#☆
MAP/mmHg	C	97±9	69±12^*	114±29^*#	116±24^*#	101±24^#	94±21^#	89±18^#	86±18^*#	134±24^*#
	P	96±6	69±11^*	103±16^#	87±14^*#☆	76±118^*#☆	72±10^*☆	70±11^*☆	68±11^*☆	108±17^*#☆
HR/(/min)	C	82±14	78±15	105±17^*#	103±15^*#	97±16^*#	95±16^*#	93±16.7^*#	90±16^#	117±18^*#
	P	77±10	69±10^*☆	92±16^*#☆	81±14^#☆	79±15^#☆	77±13^#☆	77±12^#☆	75±12^☆	98±17^*#☆
BIS	C	96±2	24±6^*	26±4^*#	29±7^*#	31±9^*#	35±9^*#	41±10^*#	47±13^*#	47±13^*#
	P	94±4	24±8^*	27±7^*	30±11^*#	34±11^*#	36±13^*#	38±12^*#	41±12^*#	42±12^*#
RPP	C	11 660±2 055	7 426±1 905^*	16 365±5 101^*#	16 433±4 415^*#	13 318±4 279^#	11 968±3 732^#	11 144±3 105^#	10 392±2 972^#	21 062±5 487^*#
	P	10 887±2 055	6 616±1 398^*☆	12 959±3 452^*#☆	9 993±2 496^#☆	8 485±2 104^*#☆	7 833±1 840^*#☆	7 421±1 741^*☆	7 087±16 230^*☆	14 743±3 665^*#☆

Items	Group C		Group P
Items	%	n	%	n
SBP+30% baseline	45	9	15^*	3
SBP-30% baseline	30	6	60	12
HR+30% baseline	65	13	25^*	5
HR-30% baseline	0	0	5	1
RPP>22 000	50	10	0^*	0