摘要
目的观察全身麻醉下鼻内镜手术中局部浸润注射含不同剂量肾上腺素的利多卡因对血流动力学影响。方法采用前瞻随机双盲对照的方法,78例择期全麻鼻内镜手术患者随机均分为三组:A组浸润注射含肾上腺素5μg/ml的1%利多卡因5ml,共25μg;B组浸润注射含肾上腺素10μg/ml的1%利多卡因5ml,共50μg;C组浸润注射不含肾上腺素的1%利多卡因5ml。术中监测采用持续ECG及桡动脉测压,记录浸润注射开始后0(基础值)、0.5、1、1.5、2、2.5、3、3.5、4和4.5minMAP和HR。结果与基础值相比,A组和B组出现明显的血流动力学变化。A组在1min和1.5min时出现明显的MAP下降(P<0.01),伴有HR增快(P<0.01),其后MAP逐渐上升,在3min达到最高值,但差异无统计学意义,然后MAP和HR逐渐平稳。B组在1min时出现明显的MAP下降(P<0.01),伴有HR增快(P<0.01),其后MAP逐渐上升,在2.5min达到最高值(P<0.01),然后MAP逐渐下降,MAP和HR逐渐平稳。结论全身麻醉下鼻内镜手术中局部浸润注射含肾上腺素的利多卡因可引起以BP先下降后上升的双相变化为主的血流动力学改变;肾上腺素用量越大,BP上升出现的越早,上升的幅度越大。
Objective To observe the hemodynamic changes caused by infiltrating nasal field with lidocaine solution containing different dose of adrenaline during functional endoscopic sinus surgery （FESS）. Methods A prospective, randomized, double blind, and clinical control trial was designed and 78 adult patients undergoing elective FESS under general anesthesia were allocated randomly to 3 groups. All patients received 1% lidocaine 5 ml with different dose of adrenaline for local infiltration：group A 25μg,group B 50μg, group C0, respectively. MAP and HR were recorded at 0 （baseline） ,0.5,1,1.5,2,2.5,3,3.5,4,and 4.5 min after the beginning of infiltration. Results Compared with the baseline,significant hemodynamic changes were observed after the beginning of infiltration in group A and B. There was a decrease in MAP at 1,1.5 min in group A and at 1 min in group B （P〈0.01） with increase in HR（P〈0.01）,and an increase in MAP at 2.5 min in group B （P〈0.01）. Conclusion Local infiltration with adrenaline-lidocaine solution causes significant changes in arterial blood pressure in a biphasic manner during FESS under general anesthesia. The more adrenaline is applied,the earlier and the more increase in MAP will present.
出处
《临床麻醉学杂志》
CAS
CSCD
2007年第2期107-109,共3页
Journal of Clinical Anesthesiology
