静脉注射利多卡因对丙泊酚全麻诱导浓度的影响

摘要

目的 观察丙泊酚靶控输注( TCI)诱导时,静脉注射不同剂量利多卡因对丙泊酚TCI诱导浓度和气管内插管血流动力学的影响,探讨其全麻诱导期应用的最适剂量. 方法 选择80例拟在全麻下行甲状腺择期手术的患者,随机分为4组,每组20例. 对照组静脉推注生理盐水3 mL( A组) ,实验组分别静脉推注利多卡因0. 5 mg/kg( B组)、1 mg/kg( C组)、1. 5 mg/kg( D组) ,1 min后开始丙泊酚TCI诱导,每30 s观察意识反应,初始血浆浓度设定为4 μg/mL,5 min后意识仍未消失的每分钟增加0. 5 μg/mL,直至意识消失. 之后给予舒芬太尼0. 4 μg/kg、罗库溴铵0. 6 mg/kg,面罩辅助通气2 min后,完成气管插管. 记录患者静脉注射利多卡因前(T0)、丙泊酚 TCI 开始(T1)、意识消失时(T2)、插管前(T3)、插管后(T4)各时点的心率(HR)、平均动脉压( MAP) ,效应室浓度( Ce)、脑电双频指数( BIS)值. 询问患者丙泊酚TCI诱导开始后是否有注射痛. 结果 T2时,B、C、D组的效应室浓度低于A组,而B、C、D组间差异无统计学意义. T2 时,各组MAP、HR比较差异无统计学意义(P>0. 05);B、C、D组气管插管前后MAP变化明显小于A组(P0. 05);插管前后,B、C、D组的BIS值变化小于A组(P0. 05). 结论 全麻诱导前静脉注射利多卡因有明显镇静作用,可显著降低丙泊酚诱导浓度,减轻气管插管的应激反应和丙泊酚的注射痛. 诱导期静脉应用利多卡因的最适剂量为1 mg/kg.%Objective To observe the effects of intravenous lidocaine of different doses on Ceof propofol TCI induction and the hemodynamics caused by endotracheal intubation,to explore the optimal dose of general anesthesia in-duction. Methods Eighty patients undergoing elective surgery of thyroidectomy were divided into four groups,twenty patients in each group. Control group received intravenous injection 0. 9% normal saline 3 mL( group A) . Experimental group received intravenous lidocaine 0. 5 mg/kg (group B),1 mg/kg(group C)or 1. 5 mg/kg (group D). Propofol TCI induction was started at 1 min fater the injection. The reaction of consciousness was observed every 30 s. The initial plasma concentration was 4μg/mL,if awareness was not disappeared after 5 min,the plasma concentration would in-crease by 0. 5μg/mL per minute,till the loss of consciousness appeared. Then the endotracheal intubation was conduc-ted at 2 min after sufentanil 0. 4μg/kg and rocuronium 0. 6mg/kg were given intravenously. The HR,MAP,Ce and BIS value before lidocaine injection ( T0 ) ,at the time points of propofol TCI beginning ( T1 ) and consciousness loss( T2 ) , before intubation (T3),after intubation (T4). The pain of patients after injection of propofol TCI induction was recor-ded. Results The Ce of group B,group C and group D was lower than that of group A at T2(P0. 05 ) . The MAP changed before and after intubation in group B,group C and group D was less than that of group A (P0. 05 );The change of BIS value before and after intubation in group B,group C and group D was less than that of group A (P0. 05). Conclusion Intravenous lidocaine be-fore induction of general anesthesia has significant sedation effect,it can significantly reduce the concentration of propo-fol during induction time and the stress response to intubation,and also improve the injection pain of propofol. The opti-mal dose of intravenous lidocaine before induction is 1 mg/kg.