尿毒症患者硬膜外腔液pH变化及碱化利多卡因在肾移植病人的应用  

The change of pH of liquid from epidural space in patients with uraemia and use of alkalinized lidocaine for renal transplantation

作　　者：胡毅平[1] 刘林汉[1] 王贵龙[1] 吴硕雄[1] 裘学[1] 

机构地区：[1]南京医科大学附属无锡第一医院麻醉科,无锡市214002

出　　处：《临床麻醉学杂志》2004年第6期338-340,共3页Journal of Clinical Anesthesiology

摘　　要：目的　测定尿毒症病人硬膜外腔液 pH变化 ,并探讨碳酸利多卡因硬膜外麻醉在肾移植病人的应用。方法　 4 5例ASAⅢ级患终末期尿毒症 (ESU)需在硬膜外阻滞下行肾移植术的病人随机分成A、B、C三组 ,各 15例。均自L 2～ 3 间隙行硬膜外穿刺置管。A组注入 1 73%碳酸利多卡因(CL) ;B组注入 1 73%碳酸利多卡因和 0 15 %丁卡因混合液 (CD) ;C组注入 1%盐酸利多卡因和0 15 %丁卡因混合液 (LD)。入室后即测定动脉血气和CVP。测定感觉阻滞平面 ,记录起效时间、阻滞完全时间、作用持续时间及追加用药量。测定三组病人不同配方药液的 pH及硬膜外腔液的pH。根据病人术前血液透析时间的差异 ,将所测结果作分类对比研究。结果　应用CL及CD的A、B两组 (药液pH >7 0 )其起效时间、阻滞完全时间与用LD的C组 (药液 pH =4 3)相比显著缩短 (P <0 0 1) ,而其作用持续时间较C组显著延长 (P <0 0 1)。C组有 7例病人追加药液的间隔时间有进行性缩短趋势 ,其中 2例发生快速耐药。且尿毒症病人硬膜外腔液 pH变化与术前血液透析时机密切相关。结论　ESU病人应用碱化利多卡因及其混合液可明显改善硬膜外阻滞的效果。Objective Tomensurate pH of liquid from epidural space in patients with uraemia,and use of alkalinized lidocaine for epidural anesthesia during renal transplantation.Methods Forty-five ASA Ⅲ patients suffered from end-stage uraemia (ESU)undergoing renal transplantation under epidural block were randomly divided into three groups with 15 cases each. The epidural puncture and catheterization were performed at L 2-3 and pH of liquid from epidural space was mensurated. In group A, 1.73% carbonic acid lidocaine (CL)was injected,and in group B,0.865% carbonic acid lidocaine plus 0.15% dicaine (CD,pH>7.0),and in group C,1% hydrochloric acid lidocaine plus 0.15% dicaine (LD,pH=4.3).Results Theonsettime and the time of blocking entirely wereshorter and the duration of action was longer in group A and B than those in group C.The change of pH of epidural space in patients with uraemia was closely correlatedto when preoperative dialysis was done.Conclusion Alkalinized lidocaine can improve the outcome of epidural blockade in the ESU patients.

关 键 词：尿毒症 pH变化 肾移植 碳酸利多卡因 硬膜外麻醉 丁卡因 

分 类 号：R614[医药卫生—麻醉学]