利多卡因局部浸润对全身麻醉鼓室成形术中血流动力学及术后镇痛的影响  

Effect of lidocaine infiltration on patients undergoing tympanoplasty surgery under general anesthesia

作　　者：乔晖[1] 范庆[1] 李文献[1] 薛期能 戴春富[2] 

机构地区：[1]复旦大学附属眼耳鼻喉科医院麻醉科,上海200031 [2]复旦大学附属眼耳鼻喉科医院耳鼻喉科,上海200031

出　　处：《中国眼耳鼻喉科杂志》2015年第3期197-199,共3页Chinese Journal of Ophthalmology and Otorhinolaryngology

摘　　要：目的观察在全身麻醉鼓室成形术前行手术区域利多卡因局部浸润对于术中血流动力学稳定及术后镇痛的效果。方法将60例拟在全身麻醉下行鼓室成形术的患者随机分为2组(n=30),L组在全身麻醉诱导完成后于手术区域(耳后手术切口及耳道内)行1%利多卡因混合1∶20万肾上腺素10 m L多点浸润注射;N组在全身麻醉诱导完成后于手术区域行0.9%生理盐水混合1∶20万肾上腺素10 m L多点浸润注射。2组患者麻醉方法相同,记录患者全身麻醉诱导完毕即刻(T1)、切皮时(T2)、耳腔成形时(T3)、出麻醉后监测治疗室(PACU)时(T4)和术后6 h(T5)的平均动脉压(MAP)及心率。记录患者PACU内的苏醒时间、镇静评分(Ramesay评分),记录患者T4和T5的疼痛程度(视觉模拟评分)。结果在T2、T3及T4,L组MAP和心率显著低于N组(P<0.05)。术后6 h 2组患者的MAP、心率差异无统计学意义(P值分别为0.143、0.094)。在PACU内,L组Ramesay评分高于N组(P=0.009)。T4、T5的镇痛评分L组显著低于N组(P值分别为0.000 2、0.043)。结论全身麻醉鼓室成形术前行手术区域利多卡因局部浸润可明显改善围术期由于创伤应激引起的血流动力学波动,同时减轻患者术后疼痛。Objective To evaluate the effect of lidocaine infiltration on hemodynamic status and postoperative analgesia in patients undergoing tympanoplasty surgery under general anesthesia. Methods Sixty patients scheduled for tympanoplasty surgery under general anesthesia were recruited in the study. The patients were randomly divided into two groups （n = 30 each）. Group L patients received local infiltration of 1% lidocaine with 1 ： 200 000 adrenaline and Group N patients received infiltration of 1 ： 200 000 adrenaline in normal saline. Anesthetic management remained the same between the two groups. Mean arterial blood pressure （MAP） and heart rate （HR） was recorded right after anesthesia induction（T1 ）, surgical incision（ T2 ）, ear cavity forming（ T3 ）, discharge from postoperative care unit（ T4 ） and 6 h postoperatively（T5 ）. Postoperative pain was assessed using visual analog scale（VAS） at T4 and T5. Anesthetic recovery time and Ramesay sedation score was recorded. Results MAP and HR was significantly lower in group L at T2, T3 and T4 （P 〈 0.05 ）. Hemodynamic status showed no significant difference between groups at T5 （P = 0. 143, P = 0. 094）. Higher Ramesay score was found in group L （P = 0.009）. There was significant lower VAS in group L （P = 0.000 2, P = 0. 043）. Conclusions Lidocaine infiltration combined with general anesthesia on patients undergoing tympanoplasty surgery provides stable hemodynamic status and favorable analgesia effect.

关 键 词：利多卡因 鼓室成形术 全身麻醉 血流动力学 镇痛 

分 类 号：R614[医药卫生—麻醉学]