摘要目的：探讨利多卡因超声雾化吸入气道表面麻醉下清醒气管插管在患者自主摆放手术体位中应用的可行性。方法选择68例需择期行全身麻醉下俯卧位手术的患者，随机方法分为对照组及观察组，每组为34例，分别采用环甲膜穿刺和面罩吸入2％利多卡因超声雾化气体进行气道表面麻醉及清醒气管插管，操作者完成气管插管后患者根据自身的舒适度配合医务人员摆放俯卧位。观察患者气管插管前后不同时间点：基础状态（T0）、气管插管即刻（T1）、插管后3 min（T2）以及翻身后即刻（T3）四个时相的平均动脉压（MAP）和心率（HR），并观察气管插管时呛咳反射发生情况。术后随访患者对气道表面麻醉效果及清醒气管插管的耐受性。结果两组患者均能顺利完成清醒气管插管及自主摆放俯卧位。观察组与对照组相比，两组患者 MAP 和 HR 数据在气管插管和体位摆放各个时相差异均无统计学意义（均 P ＞0．05）。两组患者气道表面麻醉时间、气管插管时间及呛咳反应发生率比较差异均无统计学意义（均 P ＞0．05）。结论利多卡因超声雾化吸入气道表面麻醉下清醒气管插管的方法简单实用，在患者自主摆放手术体位中应用有效可行，可以替代创伤性较大的环甲膜穿刺表面麻醉。

abstractsObjective To explore the feasibility of the ultrasonic atomization surface anesthesia with lido-caine for awake fiberoptic endotracheal intubation in patientsˊautonomous position -display before general anesthesia and to evaluate its advantages.Methods 68 adult patients who needed prone position for elective surgery under general anesthesia were selected and randomly divided into two groups,the control group and the treatment group,each group in 34 cases.In control group patients were received surface anesthesia of cricothyroid membrane puncture.In treatment group,nebulized 2% lidocaine with ultrasonic nebulizer was used for topical anesthesia.Patients lied in the prone position according to their own comfort with the guide of the medical staff in the waking state after an awake fiberoptic endotracheal intubation.The statistics of mean arterial pressure (MAP)and heart rate (HR)were recorded respectively in the basal state(T0),in the time instantly after intubations(T1 ),in the 3 minute after intubations(T2 ) and in the time instantly after the body turning(T3 ).Choking cough response were recorded during endotracheal intubation.Patients were asked the efficacy of surface anesthesia and the tolerance for awake intubation after operation.Results Patients in both two groups completed the whole process smoothly.MAP and HR had no signifi-cant differences between the two groups in the same time point (all P >0.05).There were no statistical significance between the two groups in choking cough response,the time of surface anesthesia and intubation,neither (all P >0.05).Conclusion The surface anesthesia with lidocaine by continuous ultrasonic atomizing inhalation is a good and simple method deserving generalization with plenty merits and is practicable for patients to display position autonomously. This method have the advantages of small operation,it will and can replace cricothyroid membrane puncture.