(广东省东莞市长安医院， 广东 东莞 511700)

    摘 要：目的：评价气管插管前应用地塞米松混合丁卡因用于咽喉、气管内表面麻醉后对术后病人清醒时耐管效果、拔管心血管反应及拔管后咽喉炎发病率的影响。方法：将60例病人随机等分为丁卡因混合地塞米松组(试验组)和对照组。在诱导成功后：试验组后用地塞米松5mg加1%地卡因3ml对咽喉、气管内充分表面喷雾麻醉，面罩给氧3min后插入气管导管。对照组在麻醉诱导成功后用生理盐水3ml对咽喉部、气管内表面喷雾，面罩给氧3min后插入气管导管。观察记录各组：①术后病人清醒时的耐管效果。②拔管前、拔管即刻、拔管后1、3、5min的平均动脉压(MAP)、心率(HR)。③术后24h咽喉炎发生程度和发病率。结果：全部手术在2h内完成，试验组病例清醒时的耐管效果显著优于对照组(P<0.01)。对照组病例在吸痰拔管后即刻出现MAP升高、HR加快，并延续至拔管后3min ，与拔管前相比差异有显著性 (P<0.05), 5min时恢复正常。而实验组病例在各时间点的MAP和HR与拔管前相比差异无显著性。对照组拔管后即刻、1min、3min时的HR、MAP与实验组同时点相比差异有显著性(P<0.05)。拔管后24h咽喉炎发病率显示试验组显著低于对照组(P<0. 01)。结论：气管插管前应用地塞米松混合地卡因于咽喉、气管内表面麻醉能显著增强短时手术病人术后清醒时的耐管效果，并能预防拔管时引起的心血管反应，同时减少拔管后咽喉炎的发病率。

    关键词： 地塞米松； 地卡因； 拔管心血管反应； 咽喉炎

    The Effect of Surface Anesthesia with Dexamethasone and Dicaine on the Cardiovascular Response of decannulation

    SHAN Ren-yong, YU Qing-he, CAO Zi-hua, et al

    ( Chang’an Hospital of Dongguan City , Guangdong Dongguan 511700 , China )

    Abstract : Objective: To evaluate the cardiovascular response of decannulation and themorbidity rate of dexamethasone resulted from the surface anesthesia with ethasonedexam and dicaine.Method: 60 cases were divided into experiment group and control group randomly. In the experiment group , the surface atomization anesthesia were applied to throat and trachea with 5mgDexamethasone and 3ml 3%dicaine .And then insert the endotracheal tube after 3min face mask oxygen inhalation while in the control group ,3ml physiological saline were applied to troat and trachea atomization and then with endotracheal tube after 3min face mask oxygen inhalation , and then recorded the record of both groups:1.the response to the tube when the patients were conscious 2. the MAP HR before decannulation and after 1min ,3min , 5min.3 .the morbidity rate of laryngopharyngitis within 24 hours after operation. Result: All the operation were finished in 2 hours. In the experiment group, the patients were consciouns and tolerate to the tube .While, in the control group, MAP decreased , HR were faster, and it was exist till after removing the tube 3min.There’s difference compared with before removing ( p<0.05 ). It was better after 5min. There’s no significant difference in the experiment group.In the control group , There’s significant difference in HR, MAP after 1 min , 3 min removing ( p<0.05 ) . The morbidity of laryngopharyngitis is less than control group within 24 hours. Conclusion :The surface anesthesia with dexamethasone combined with dicaine on throat and trachea are tolerate to the tube .When the patients are conscious and it can prevent the cardiovascular response of decannulation and decrease the morbidity of laryngopharyngitis. ......