目的 观察盐酸达克罗宁胶浆用于门诊消化内镜手术全麻清醒慢诱导插管时的表面麻醉效果。方法 选取2019年8—12月解放军总医院第一医学中心门诊消化内镜中心全麻气管插管下接受手术治疗的患者70例,手术为经口内镜下环形肌切开术(peroral endoscopic myotomy, POEM)和内镜黏膜下剥离术(endoscopic submucosal dissection,ESD),随机分为盐酸达克罗宁胶浆口含组(达克罗宁组,35例)和丁卡因喷雾组(丁卡因组,35例)。全麻诱导方式采取健忘镇痛清醒慢诱导气管插管,达克罗宁组使用盐酸达克罗宁胶浆(0.1 g/10 ml)口含表面麻醉,丁卡因组使用1%丁卡因喷壶喷雾表面麻醉,总量≤2 ml。观察记录6个不同时间点的血压及心率变化。并记录气管插管前口咽部麻木感评分、插管用时(s)及次数、拔管时呛咳和咽喉痛发生率及术后24 h和48 h 咽喉部疼痛情况,采用VAS评分法。结果 两组一般资料及手术时间无统计学差异。达克罗宁组气管插管即刻(T₂)、气管插管完成后5 min(T₃)、左侧卧位后3 min (T₄)、拔管即刻(T₅)MAP均低于丁卡因组,差异有统计学意义(P<0.01)。两组不同时间段HR差异无统计学意义。达克罗宁组较丁卡因组插管时间短[(18.37±2.78)s vs. (22.49±6.62)s, P<0.01],但两组口咽麻木感差异无统计学意义。拔管时达克罗宁组呛咳(20.0%)和咽喉痛发生率(5.7%)低于丁卡因组(69.6%,42.9%,P<0.01)。达克罗宁组术后24 h咽喉痛评分(0.66±1.33)低于丁卡因组(2.09±1.87),差异有统计学意义(P<0.01),但术后48 h咽喉痛评分两组差异无统计学意义。结论 盐酸达克罗宁胶浆可提供良好的口咽部表面麻醉效果,与丁卡因喷雾相比,患者血流动力学更平稳,操作过程更简洁方便,毒性低,安全性高。

Objective To observe the topical anesthesia effect of dyclonine hydrochloride mucilage used in slow induction intubation during digestive endoscopic surgery among outpatients.Methods Between August 2019 and December 2019, 70 patients who received surgical treatment under general anesthesia with endotracheal intubation in the Digestive Endoscope Center of the First Medical Center of the Chinese PLA General Hospital were randomly divided into two groups: 35 cases in the oral dyclonine hydrochloride mucilage group (the dyclonine group) and 35 cases in the tetracaine spray group (the tetracaine group). Peroral endoscopic myotomy (POEM) and endoscopic submucosal dissection (ESD) were adopted. The induction method of general anesthesia was amnesia, analgesia and wakening, and slow induction of endotracheal intubation. The dyclonine group was given dyclonine hydrochloride mucilage (0.1 g/10 ml) for oral topical anesthesia, while the tetracaine group received 1% tetracaine spray for topical anesthesia, with the total amount no more than 2 ml. The changes of blood pressure and heart rate at six different time points were observed and recorded. The scores of numbness in the oropharynx before endotracheal intubation, the duration (s) and frequency of intubation, the incidence of cough and sore throat during extubation, and the severity of throat pain at 24 h and 48 h after endotracheal intubation were recorded using the VAS score.Results There was no significant difference in the basic data and duration of surgery between the two groups. MAP of the dyclonine group immediately after intubation (T₂), 5 min after intubation (T₃), 3 min after left lateral positioning (T₄) and immediately after extubation (T₅) was significantly lower than that of the tetracaine group. There was no significant difference in HR between the two groups at different time points. The duration of intubation in the dyclonine group was shorter than that of the tetracaine group [(18.37±2.78)s vs. (22.49±6.62)s, P<0.01], but there was no significant difference in levels of oropharyngeal numbness between the two groups. The incidence of cough and sore throat in the dyclonine group (20.0%, 5.7%) was lower than in the tetracaine group (69.6%, 42.9%, P<0.01) . The score of sore throat in the tetracaine group (0.66±1.33) was lower than that of the tetracaine group (2.09±1.87) at 24 hours postoperatively (P<0.01), but there was no significant difference between the two groups at 48 hours after operation.Conclusions Dyclonine hydrochloride mucilage can deliver good oropharyngeal topical anesthesia effect when used in awake and slow induction with endotracheal intubation during digestive endoscopic surgery. Compared with tetracaine spray, the hemodynamics of patients is more stable. Dyclonine hydrochloride mucilage has many advantages over tetracaine spray in outpatient surgery.