静脉使用利多卡因在无痛纤维支气管镜检查中的应用  

Application of Intravenous Lidocaine in Patients Undergoing Fiberoptic Bronchoscopy with General Anesthesia

作　　者：张君[1] 牧杰[1] 张翔[1] 王儒蓉[1] 

机构地区：[1]四川大学华西医院麻醉科,成都610041

出　　处：《华西医学》2015年第8期1465-1468,共4页West China Medical Journal

基　　金：国家自然科学基金(81170077)~~

摘　　要：目的评估静脉给予利多卡因是否可以减轻无痛纤维支气管镜检查过程中的应激反应。方法 2013年11月-2014年7月以60例拟行全身麻醉下纤维支气管镜检查的患者为研究对象,随机分为利多卡因组(n=30)和对照组(n=30),利多卡因组在诱导时静脉给予利多卡因1 mg/kg,随即持续泵注2%利多卡因3 mg/(kg·h);对照组以同样的方法给予等体积生理盐水,全身麻醉诱导后置入喉罩,观察并记录诱导前即刻、诱导后即刻、置入喉罩后即刻、纤维支气管镜通过隆突时和出室前的收缩压、舒张压、平均动脉压、脉搏氧饱和度、心率,观察纤维支气管镜通过隆突时是否出现呛咳,利多卡因静脉注射后是否出现局部麻醉药中毒表现及丙泊酚的注射痛。结果所有患者均顺利完成纤维支气管镜检查,在纤维支气管镜通过气管隆突时血压和心率均有不同程度的升高,两组间的变化程度比较差异无统计学意义(P>0.05)。利多卡因组耳鸣、口舌麻木的发生率高于对照组,但差异无统计学意义(P>0.05)。利多卡因组注射痛的发生率明显低于对照组,差异有统计学意义(P<0.05)。结论静脉给予利多卡因不能有效抑制纤维支气管镜检查引起的应激反应。Objective To evaluate if intravenous lidocaine can reduce the stress response induced by fiberoptic bronchoscopy in patients under general anesthesia. Methods Sixty patients undergoing fiberoptic bronchoscopy under unconsciousness between November 2013 and July 2014 were randomly divided into two groups： lidocaine group （n=30） and control group （n=30）. Patients in the lidocaine group received an intravenous injection oflidocaine for I mg/kg during induction and then continuous intravenous infusion of 2% lidocaine with a dose of 3 mg/（kg · h）. The same volume of saline was given to patients of the control group in the same way. Laryngeal mask airway was placed after anesthesia induction. Variables of heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and pulse oxygen saturation were observed and recorded at five time points： before induction, immediately after induction, immediately after laryngeal mask airway placement, fiberoptic bronchoscopy across tracheal carina and before leaving examination room. Complications including cough reflex, toxicity reaction of local anesthetics, and injection pain were also observed. Results The examination was successfully completed in all patients. Blood pressure and heart rate increased in all patients when fiberoptic bronchoscopy got across tracheal carina. There were no statistically significant differences in the two groups （P 〉 0.05）. Patients in the two groups had no statistic difference in tinnitus and numbness of tongue （P 〉 0.05）. Compared with the control group, patients in the lidocaine group had lower incidence of injection pain （P 〈 0.05）. Conclusion Intravenous lidocaine cannot suppress stress response induced by fiberoptic bronchoscopy effectively.

关 键 词：利多卡因 纤维支气管镜 全身麻醉诱导 喉罩 

分 类 号：R614[医药卫生—麻醉学]