心电图导联的选择不影响肾上腺素注射所致心电图T波改变的标准  

Does the Choice of Electrocardiography Lead Affect the Efficacy of the T-Wave Criterion for Detecting Intravascular Injection of an Epinephrine Test Dose?

作　　者：肖霖[1] 杨映红[1] 

机构地区：[1]江苏大学附属人民医院麻醉科,江苏镇江212001

出　　处：《江苏大学学报（医学版）》2004年第2期126-129,共4页Journal of Jiangsu University：Medicine Edition

摘　　要：目的 :在麻醉病人中模拟血管内注射试验量肾上腺素 ,心电图导联的选择是否会影响T波标准判断的有效性。方法 :35例患者均术前禁食 8h ,无麻醉前用药 ,气管插管后应用靶控输注丙泊酚维持麻醉 ;等待血流动力学稳定后所有患者先注射 3ml生理盐水 ,4min后注射 1 5 %的利多卡因 3ml(含 1∶2 0万的肾上腺素 ) ,分别在注射生理盐水和试验量后持续监测记录心率、收缩压、心电图Ⅱ (n =35 )和V5(n =35 ) ,及Ⅰ (n =17)或Ⅲ (n =18)导联 4min。结果 :注射试验量显著增加心率和收缩压 ,显著降低所有导联的T波振幅 ;注射生理盐水这些参数则无变化。在心电图Ⅰ ,Ⅱ ,Ⅲ和Ⅴ5导联T波振幅降低的最大幅度分别为 :(- 87± 13) % ,(- 88± 8) % ,(- 94± 15 ) %和 (- 86±16 ) % (M±s;P >0 0 5 )。在心电图 4导联中T波振幅的变化无显著性差异 ,如果以T波标准为基础则 4导联监测都具有 10 0 %的敏感性和特异性。结论 :心电图Ⅰ ,Ⅱ ,Ⅲ和Ⅴ5导联T波振幅的降低对检测丙泊酚成人麻醉中血管内误注含肾上腺素的试验量具有相当的有效性。Objective: To test whether the choice of EKG lead would affect the efficacy of the simulated intravascular test dose in anesthetized patients. Methods: After an 8 h fast and without premedication, 35 healthy patients were anesthetized with diprivan after endotracheal intubation.When hemodynamic stability was obtained, all subjects received 3 ml of normal saline IV. followed 4 min later by 1.5% lidocaine 3 mL plus 15 μg of epinephrine (1∶200,000) IV. Heart rate,systolic blood pressure, Leads Ⅱ or Ⅲ were continuously recorded for 4 min after the saline and test-dose injections. Results: An IV. test dose produced significant increase of heart rate and systolic blood pressure,and produced decrease of the T-wave amplitude of all EKG leads studied in all subjects, whereas IV. saline elicited no changes in these parameters. The maximum percentage decreases in T-waveamplitude of Leads were(-87±13)%,(-88±8)%,(-94%±15)%, and (-86±16)%,respectively (M±s; P>0.05). There was no significant difference in temporal changes in T-wave amplitude among the 4 leads, and sensitivity and specificity were 100% on the basis of the T-wave criterion, irrespective of the lead examined. Conclusion: Leads Ⅱ, Ⅰ, Ⅲ, and V 5 of the EKG are equally effective for detecting intravascular injection of the epinephrine-containing test dose in diprivan-anesthetized adults.

关 键 词：硬膜外 麻醉 心电图 肾上腺素试验剂量 

分 类 号：R614[医药卫生—麻醉学]