【罂粟摘要】清醒气管插管改良黏膜麻醉的新方法:一项前瞻性、盲评、随机对照试验
清醒气管插管改良黏膜麻醉的新方法:一项前瞻性、盲评、随机对照试验
贵州医科大学 高鸿教授课题组
翻译：曹莹 编辑：佟睿 审校：曹莹
表面麻醉是清醒气管插管中提供良好插管条件的关键环节。本院清醒插管的标准护理技术，包括口咽部喷施丁卡因，可能导致粘膜麻醉效果不佳。因此，我们试图比较在上呼吸道清醒气管插管表面麻醉时，使用盐酸达克罗宁胶浆和丁卡因的效果。
本研究为随机、盲评、前瞻性研究。选择2019年6月1日至2019年8月1日拟行内镜黏膜下剥离或经口内镜肌切开术的患者，在获得书面知情同意后随机分为两组:新型清醒式插管护理的患者(N-AIC)组，单次口服盐酸达克罗宁胶浆；标准清醒插管护理的患者(S-AIC)组，清醒插管前接受三次丁卡因经口咽喷雾+环甲膜剂注射。在整个清醒插管过程中，本研究的主要结果是记录并比较两组之间平均动脉压(MAP)以及心率(HR)。次要观察结果包括麻木感、恶心和表面麻醉后插管情况也被评估。
60例患者入选并完成研究。两组间基础MAP和HR相似。然而，N-AIC组对插管和胃肠道内镜的血流动力学反应尤其是MAP的升高明显降低。表面麻醉后两组患者口咽粘膜的麻木程度没有差异，在喉镜检查时也没有恶心的感觉。N-AIC组插管前咽部分泌物较少。N-AIC组插管时间较S-AIC组明显缩短(18.4±2.86 vs. 22.3±6.47, P＜0.05)。N-AIC组拔管时角弓反张发生率明显降低(13.3% vs.76.7%)。N-AIC组患者拔管后咽痛的发生率低于S-AIC组(6.7% vs. 43.3%)。本研究未观察到由丁卡因或达克罗宁引起的不良副作用。
在清醒气管插管中，与标准口咽丁卡因喷雾剂相比，采用口服盐酸达克罗宁胶浆的新型护理能提供更有利的粘膜麻醉和更好的插管条件。
Improving mucosal anesthesia for awake endotracheal intubation with a novel method: a prospective, assessor-blinded, randomized controlled trial
Background: Topical anesthesia is a crucial step in awake endotracheal intubation for providing favorable intubation conditions. The standard of care technique for awake intubation at our institution, which consists of oropharyngeal tetracaine spray, can result in inadequate mucosal anesthesia. Therefore, we sought to compare the effectiveness of dyclonine hydrochloride mucilage to the standard of care tetracaine in achieving anesthesia of the upper airways for awake endotracheal intubation.
Methods: This is a randomized, assessor-blinded, prospective study. From Jun. 1st, 2019 to Aug. 1st, 2019, patients scheduled for either endoscopic submucosal dissection or peroral endoscopic myotomy were enrolled and randomly allocated into two groups after obtaining written informed consent: patients allocated to novel awake intubation care (Group N-AIC) received a single administration of oral dyclonine hydrochloride mucilage, whereas patients allocated to standard awake intubation care (Group S-AIC) received three oropharyngeal tetracaine sprays before transcricoid tetracaine injection before awake intubation. Mean arterial pressure (MAP), which was the primary outcome of this study, as well as heart rate (HR) were recorded throughout the procedure and compared between the two groups. Feeling of numbness, nausea, and intubation conditions after topical anesthesia were also assessed.
Results: Sixty patients were enrolled and completed the study. Baseline MAP and HR were similar between the two groups. However, hemodynamic responses to intubation and gastrointestinal endoscopy, especially MAP, were significantly less elevated in Group N-AIC. The degree of numbness of the oropharyngeal mucosa after topical anesthesia did not differ between the two groups, neither did the feeling of nausea during laryngoscopy. The amount of pharyngeal secretions before intubation was less in Group N-AIC. Total intubation time was significantly shorter in Group N-AIC when compared to Group S-AIC (18.4 ± 2.86 vs. 22.3 ± 6.47, P < 0.05). Extubation bucking was significantly less frequent in Group N-AIC (13.3% vs. 76.7%). Patients received in Group N-AIC had a lower rate of post-extubation sore throat compared to Group S-AIC (6.7% vs. 43.3%). No adverse side effects attributable to either tetracaine or dyclonine were observed in this study.
Conclusions: In awake endotracheal intubation, novel care using oral dyclonine hydrochloride mucilage can provide more favorable mucosal anesthesia and better intubation conditions compared to standard of care practice using oropharyngeal tetracaine spray.
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