天津医药

天津医药 ›› 2015, Vol. 43 ›› Issue (9): 1047-1049.doi: 10.11958/j.issn.0253-9896.2015.09.025

• 药物临床观察 • 上一篇    下一篇

单次静脉注射利多卡因对七氟烷最低肺泡有效浓度影响的研究

张伟1,于泳浩2△   

  1. 1天津医科大学研究生院 （邮编300070） ;2天津医科大学总医院麻醉科
  • 收稿日期:2015-01-04 修回日期:2015-03-13 出版日期:2015-09-15 发布日期:2015-09-15
  • 通讯作者: △通讯作者 E-mail： yuyonghao@126.com E-mail:yuyonghao@126.com
  • 作者简介:张伟 （1979）， 男， 主治医师， 硕士在读， 主要从事临床麻醉方面的研究

The effects of a single IV lidocaine bolus dose on the minimal alveolar concentration of sevoflurane

ZHANG Wei1, YU Yonghao2△   

  1. 1 Graduate School of Tianjin Medical University, Tianjin 300070, China;. 2 Department of Anesthesiology, Tianjin Medical
    University General Hospital
  • Received:2015-01-04 Revised:2015-03-13 Published:2015-09-15 Online:2015-09-15
  • Contact: △Corresponding Author E-mail:yuyonghao@126.com E-mail:yuyonghao@126.com

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摘要： 目的 评价静脉注射不同剂量利多卡因对七氟烷最低肺泡有效浓度(MAC)的影响。方法 将90 例择期行躯干部手术患者随机均分为利多卡因高剂量组 （H组）、 低剂量组 （L组） 和对照组 （C组）。七氟烷吸入诱导、 置入喉罩后维持七氟烷预设浓度15 min以上， 于切皮前3 min静脉注射试验药物， H、 L组分别给予2%利多卡因1.5、 0.75 mg/kg， C 组给予0.9%生理盐水 5 mL。给药后3 min 时切皮， 观察切皮时及切皮后1 min 内患者切皮反应 （有无体动）。采用序贯法来确定七氟烷MAC。并记录监护后1 和5 min （取平均值记为T0 ）、 给药前即刻 （T1 ）、 切皮前即刻 （T2 ）、 切皮后1 min （T3 ） 的心率 （HR）、 平均动脉压 （MAP） 及双频脑电指数 （BIS）。结果 H 组七氟烷 MAC （2.00%±0.17%） 在数值上比 C 组 （2.22%±0.18%） 平均降低约 0.22%， 比 L 组 （2.21%±0.14%） 平均降低约 0.21% （F=7.054， P＜0.05）； L 组与C 组差异无统计学意义。HR、 MAP 和 BIS 在 3组内均是 T2时降低， T3时升高 （均P＜0.05）。HR、 MAP、 BIS 在 T0、 T1时各组间差异均无统计学意义。HR、 BIS在T2、 T3时H组低于C、 L组； MAP在T2、 T3时L、 H组均低于C组， 在T2时H组低于L组（均 P＜0.05）。结论 单次静脉注射 1.5 mg/kg 利多卡因可降低七氟烷 MAC， 但降幅 （11%） 未达预期。

关键词: 利多卡因, 注射, 静脉内, 麻醉, 最低肺泡有效浓度, 七氟烷

Abstract: Objective To evaluate the effects of a single IV lidocaine bolus dose on the minimal alveolar concentration （MAC）of sevoflurane. Methods Patients (n=90), aged 25-65 years whose Anesthesiologists (ASA) classification was Ⅰ or Ⅱ and underwent elective surgery on trunk under general anesthesia, were randomly divided into 3 groups with 30 cases in each group： high-dose lidocaine group (group H), low-dose lidocaine group (group L) and control group (group C). They were induced by sevoflurane inhalation, and ventilated by LMA (laryngeal mask airway). After a 15 minutes equilibration period with the above sevoflurane concentration , the medication to be studied (2% lidocaine 1.5 mg/kg for group H , 2% lidocaine 0.75 mg/kg for group L, 0.9% saline 5mL for group C) was administered for 3 minutes before the skin incision. The response to skin incision (movement versus no movement) was recorded in the first minute after skin incision. The MAC for sevoflu⁃ rane was determined using the Dixon′s up and down method. Values of mean arterial pressure (MAP), heart rate (HR), and BIS were recorded at 1 minute and 5 minutes after being monitored (average values were noted as T0), immediately before the administration of medication (T1), immediately before the skin incision (T2) and 1 minute after the skin incision(T3). Results MAC in group H (2.00%±0.17%) was lower than that in group C (2.22%±0.18%) by approximately 0.22%,and which was lower than that of group L ( 2.21%±0.14%) by approximately 0.21%（F=7.054， P < 0.05） . No significant differ⁃ ence in the MAC of sevoflurane was noted between group L and group C. The values of HR, MAP and BIS all decreased at T2 and increased at T3 in all 3 groups (all P < 0.05). No significant difference in HR, MAP or BIS was observed between T0 and T1 in all three groups. The values of HR and BIS were lower in group H than those in group C and group L at T2 and T3. The values of MAP were lower in group L and group H than those in group C at T2 and T3. The value of MAP were lower in group H than that in group L at T2（all P＜0.05） . Conclusion A single Ⅳ 1.5 mg/kg lidocaine decreases MAC of sevoflurane, but the decreased amplitude (11%) does not reach expectation.

Key words: lidocaine, injections, intravenous, anesthesia, minimal alveolar concentration (MAC), sevoflurane