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| 雾化吸入利多卡因在强直性脊柱炎患者经鼻清醒气管插管中的应用 |
| Application of aerosol inhalation of lidocaine for awake fiberoptic nasotracheal intubation in patients with ankylosing spondylitis |
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| DOI：10.12089/jca.2025.03.010 |
| 中文关键词: 利多卡因 表面麻醉 清醒气管插管 雾化吸入 强直性脊柱炎 |
| 英文关键词: Lidocaine Surface anesthesia Awake tracheal intubation Aerosol inhalation Akylosing spondylitis |
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| 中文摘要: |
目的： 观察雾化吸入利多卡因表面麻醉用于强直性脊柱炎（AS）患者经鼻清醒气管插管的效果。
方法：选择纤维支气管镜引导经鼻清醒气管插管AS患者68例，男61例，女7例，年龄35～64岁，BMI 18.5～30.0 kg/m2 ，ASA Ⅰ或Ⅱ级。采用随机数字表法将患者分为两组：观察组和对照组，每组34例。观察组雾化吸入2%利多卡因5 ml实施表面麻醉；对照组使用2%利多卡因3 ml咽喉部喷雾及2%利多卡因2 ml环甲膜穿刺注射实施表面麻醉。记录插管前、插管时、插管后即刻、插管后3 min的HR、MAP、SpO2及BIS。评估插管时镇静和躁动评分（SAS），采用Cormark-Lehame（C-L）分级评估镜下声门暴露情况，采用改良经鼻气管插管困难量表（NIDS）对插管条件进行量化评估。记录纤维支气管镜通过鼻腔时间、声门暴露时间、插管总时间、插管次数、首次插管成功例数。记录插管时呛咳、喉痉挛、鼻黏膜出血、声音嘶哑等并发症的发生情况。
结果：与插管前比较，插管时、插管后即刻对照组HR明显增快、MAP明显升高（P<0.05）。与对照组比较，插管时、插管后即刻观察组HR明显减慢、MAP明显降低、SpO2明显升高（P<0.05），插管时SAS评分明显降低，C-L分级Ⅰ和Ⅱ级比例明显升高，Ⅳ级比例明显降低，插管无困难比例明显升高，轻度困难比例明显降低（P<0.05）；鼻腔通过时间、声门暴露时间、插管总时间明显缩短，插管1次和2次成功比例及首次插管成功比例明显升高（P<0.05）；插管时呛咳、喉痉挛、鼻黏膜出血、声音嘶哑比例明显降低（P<0.05）。
结论： 雾化吸入2%利多卡因能更好满足强直性脊柱炎患者经鼻清醒气管插管表面麻醉的需要，改善插管所致的心血管应激反应，降低插管难度，缩短插管时间，提高成功率，减少并发症。 |
| 英文摘要: |
Objective: To observe the effect of surface anesthesia achieved through aerosolized lidocaine inhalation in patients with ankylosing spondylitis undergoing awake fiberoptic nasotracheal intubation.
Methods: Sixty-eight patients with ankylosing spondylitis undergoing awake transnasal tracheal intubation guided by fiber bronchoscopy video were included, 61 males and 7 females, aged 35-64 years, BMI 18.5-30.0 kg/m2 , ASA physical status Ⅰ or Ⅱ. Patients were divided into two groups by randomized numerical table method: the observation group and the control group, 34 patients in each group. The observation group underwent the surface anesthesia through aerosol inhalation of 2% lidocaine by 5 ml, and the control group underwent the surface anesthesia through throat spray with 2% lidocaine by 3 ml and cricothyroid puncturing injection with 2% lidocaine by 2 ml. HR, MAP, SpO2, and BIS were recorded before intubation, upon intubation, immediately after intubation and 3 minutes after intubation. Sedation and agitation scores (SAS) were assessed upon intubation, the Cormark-Lehame (C-L) classification was adopted to assess microscopic glottis exposure, an improved nasal intubation difficulty scale (NIDS) was adopted to quantitatively assess the intubation conditions. Bronchoscopic nasal passage duration, glottis exposure duration, complete intubation duration, intubation times, and successful initial intubation cases were recorded. The intubation-associated complications were recorded, including bucking, laryngospasm, rhinorrhagia and hoarseness.
Results: Compared with before intubation, HR and MAP in the control group were significantly decreased during intubation and immediately after intubation (P < 0.05). Compared with the control group, HR was significantly slowed down, MAP was significantly decreased, and SpO2 was significantly increased during and immediately after intubation in the observation group (P < 0.05), the SAS score was significantly decreased during intubation, the proportion of C-L grade Ⅰ and Ⅱ was significantly increased, the proportion of C-L grade Ⅳ was significantly decreased, the proportion of no difficulty was significantly increased, and the proportion of mild difficulty was significantly decreased in the observation group (P < 0.05), the nasal passed time, glottis exposure time, and total intubation time were significantly shortened, the proportion of successful intubation at first attempt and twice, and the proportion of successful intubation at first attempt were significantly increased (P < 0.05), the proportion of cough, laryngospasm, nasal mucosal bleeding, and hoarseness during intubation was significantly decreased (P < 0.05).
Conclusion: Aerosol inhalation of 2% lidocaine can mitigate the cardiovascular stress reaction triggered by intubation, ease the difficulty in intubation, shorten the intubation duration, increase the success rate in intubation, and reduce the intubation-associated complications, thus better meeting the demand for surface anesthesia through awake transnasal tracheal intubation of patients with ankylosing spondylitis. |
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