不同浓度利多卡因颈段硬膜外阻滞对猫呃逆反射的作用  

Effects of cervical epidural block with different concentrations of lidocaine on hiccup reflex in cats

作　　者：任宪凤[1] 郑方[1] 李文志[1] 牛骊[2] 李洪波[1] 王四清[1] 

机构地区：[1]哈尔滨医科大学附属第二医院麻醉科,150086 [2]解放军第二一一医院麻醉科

出　　处：《中华麻醉学杂志》2007年第4期319-323,共5页Chinese Journal of Anesthesiology

基　　金：黑龙江省卫生厅课题（2006-128）;哈尔滨医科大学附属第二医院青年基金资助项目（QN2006-02）

摘　　要：目的 探讨不同浓度利多卡因颈段硬膜外阻滞对猫呃逆反射的作用。方法 30只健康家猫,体重2．1～3．9kg,随机分为5组,每组6只。以一棉签机械刺激咽背部引发呃逆反射,建立呃逆模型,于枕骨大孔和颈1（C1）间隙穿刺,并置管于颈4（C4）硬膜外腔水平。通过硬膜外导管分别注射0．5 ml/kg的生理盐水（C组）、0．5%利多卡因（L0．5组）、1%利多卡因（L1．0组）、1．5%利多卡因（L1．5组）和2%利多卡因（L2．0组）,并于给药前（T0）及给药后30min（T1）、60min（T2）、90min（T3）、120min （T4）、150min（T5）、180min（T6）和210min（T7）行咽背部机械刺激,记录食道压和环勺后肌（PCA）、腹外斜肌（ABD）及膈肌（DIA）的肌电图。计算刺激前后食道压负向波峰数值的平均值之差（DPes）。结果 T0时棉签刺激发生呃逆,DIA活动增强,PCA、ABD活动减弱;T1-7时,L0．5组、L1．0组、L1．5组、L2．0组机械刺激前后DIA、PCA、ABD活动无明显变化。与C组比较,L0．5组、L1．0组、L1．5组、L2．0组在T1～7时DPes减小（P＜0．05）;L0．5组、L1．0组、L1．5组、L2．0组间各时间点DPes差异无统计学意义（P＞0．05）;与T0比较,T1～7时L0．5组、L1．0组、L1．5组、L2．0组DPes减小（P＜0．05）。结论 0．5%～2%利多卡因颈段硬膜外阻滞可以有效阻断猫呃逆反射。Objective To investigate the effects of cervical epidural block with different concentrations of lidocaine on hiccup reflex. Methods Thirty healthy cats of both sexes weighing 2.1-3.9 kg were anesthetized with intraperitoneal pentotarbital 30 mg/kg, tracheostomized and mechanically ventilated. PETCO2 was maintained at 25- 30 mm Hg. Bipolar stainless-steel wire electrodes were implanted in the posterior cricoarytenoid muscle （PCA） of larynx, external oblique muscle of abdomen （ABD） and the costal diaphragm （DIA） for electromyographic （EMG） monitoring. A thin-walled latex balloon was positioned in the middle third of the esophagus and connected to a differential pressure transducer for the measurement of esophageal pressure （Pes） as an index of intrapleural pressure. Hiccup was elicited by mechanical stimulation of the posterior wall of epipharynx at the mid-inspiration during mechanical ventilation. An epidural catheter was placed at the interspace between C1 and occipital foramen magnum and advanced candad until C4. Normal saline, 0.5%, 1.0%, 1.5% and 2.0% lidocaine 0.5 ml/kg was injected via the epidural catheter in group 1-5 （ n = 6 each） respectively. Hiccup was then elicited before （To） and at 30, 60, 90, 120, 150, 180 and 210 min after epidural injection （T1-7）. EMG changes of PCA, ABD and DIA and the changes in the peak negative esophageal pressure （nPes） were recorded at each time point. The magnitude of the hiccup was measured as the difference （DPes） of the mean value of nPes calculated before and after stimulation. Results Mechanical stimulation of the posterior wall of epipharynx before epidural injection at To rapidly inhibited the ongoing PCA and ABD activity while DIA activity exhibited spasmodic burst consisting of discharges of very large amplitude on EMG. After epidural injection at T1-7 no significant changes in EMG was found with mechanical stimulation. The values of DPes after epidural injection at T1-7 were significantly decreased as compared with the b

关 键 词：利多卡因 麻醉 硬膜外 呃逆 

分 类 号：R686[医药卫生—骨科学]