【摘要】 目的探讨静脉注射不同剂量利多卡因对青壮年患者腰椎手术中气管插管致心血管应激以及呛咳反应的影响。方法择期全麻下行腰椎手术的青壮年患者60例,随机数字表法分为对照C组、试验L₁组和试验L₂组,每组各20例。全麻诱导:3组患者均依次静脉注射咪达唑仑0.05 mg/kg,舒芬太尼0.5μg/kg,顺式阿曲库铵0.2mg/kg,丙泊酚血浆靶控浓度3μg/ml,而后试验L₁组、L₂组分别静脉注射利多卡因1 mg/kg、2 mg/kg,对照C组注射生理盐水10 ml。观察记录3组患者进入手术室时（T₀）、麻醉诱导前（T₁）、插管即刻（T₂）、插管后1 min（T₃）、3 min（T₄）、 5 min（T₅）时心率、平均动脉压值,并于T₀和T₃时抽取外周静脉血,测定血浆中去甲肾上腺素以及肾上腺素的浓度。记录诱导过程中心血管不良反应（高血压、低血压、心动过缓及其心动过速）及呛咳反应的发生情况。结果与对照C组比较,试验L₁组、L₂组心率、平均动脉压在T₃和T₄时间点下降（P<0.05）,与试验L₁组比较,试验L₂组心率、平均动脉压下降（P<0.05）;与对照C组比较,试验L₁组和试验L₂组去甲肾上腺素和肾上腺素的血浆浓度在T₃时间点下降（P<0.05）;与对照C组比较,试验L₁组、试验L₂组心动过缓反应的发生率增加（P<0.05）,高血压、心动过速反应、呛咳反应发生率降低（P<0.05）。结论静脉注射利多卡因2 mg/kg能更好地稳定青壮年患者腰椎手术麻醉诱导过程中的血流动力学,减少诱导期呛咳反应的发生。更多还原

【Abstract】 Objective To study the influences of different doses of lidocaine by intravenous injection during endotracheal intubation on cardiovascular stress and choking effect in lumbar surgery of young adults.Methods Sixty young adults underwent elective lumbar surgery under general anesthesia,were randomly divided into control group C,experimental group L₁ and group L₂ with 20 cases in each group. Induction of general anesthesia:Midazolam 0.05 mg/kg,sufentanil 0.5μg/kg,cisatracurium 0.2 mg/kg and propofol 3μg/ml were intravenously injected in all three groups. Then lidocaine 1 mg/kg and 2 mg/kg were intravenously injected in group L₁ and L₂,respectively,and saline 10 ml was injected in group C. HR and MAP values were recorded at the time of entering the operating room（T₀）,before anesthesia induction（T₁）,immediately after intubation（T₂）,1 min after intubation（T₃）,3 min（T₄）,5 min（T₅）. Peripheral venous blood was extracted at T₀ and T₃ to determine plasma norepinephrine and epinephrine levels. Cardiovascular adverse reactions（hypertension,hypotension,bradycardia and tachycardia） and cough response were recorded during induction. Results Compared with control group C,HR and MAP in experimental L₁ group and L₂ group decreased at T₃ and T₄ time points（P<0.05）. Compared with experimental L₁ group,HR and MAP in experimental L₂ group decreased（P<0.05）. Compared with control group C,plasma concentrations of norepinephrine and epinephrine in experimental L₁ group and experimental L₂ group decreased at T₃ time point（P <0.05）. Compared with control group C,the incidence of bradycardia increased in experimental L₁ and L₂ groups（P<0.05）,while the incidence of hypertension,tachycardia and cough decreased（P<0.05）. Conclusion Intravenous injection of lidocaine at 2 mg/kg can stabilize the hemodynamics during anesthesia induction of lumbar surgery in young and middle-aged patients,and reduce the occurrence of cough during induction.更多还原