硬膜外利多卡因阻滞时抗室性心律失常的利多卡因给药方案探讨

Study of Remedy with Lidocaine for Antiarrhythmia during Lidocaine Epidural Blockade

18例成年病人,随机分成三个组:硬膜外利多卡因3.2mg/kg组,硬膜外利多卡因加1∶20万肾上腺素3.2mg/kg组和静注利多卡因1mg/kg组。利多卡因药时曲线变化规律符合二室开放药代动力学模型,并按一级速率过程进行消除。硬膜外腔注入利多卡因后血药浓度峰值为3.7±1.4μg/ml和2.6+0.6μg/ml,达峰时间为13.5±3.6min和16.4±3.6min。t 1/2Ka为2.901±1.305min和3.464±2.163min.t 1/2β为148.158±41.298min和167.820±34.611 min,CL为6.991±1.124ml/kg/min和6.842±1.820ml/kg/min,Vc为0.677±0.204L/kg和0.946士0.215L/kg。静注利多卡因组Co为3.3士0.8μg/ml,t 1/2β为104.541±50.213min,CL为9.744±2.122ml/kg/min.Vc为0.323士0.127L/kg。本文用药代动力学原理和公式对硬膜外利多卡因阻滞时抗室性心律失常的利多卡因给药方案进行了探讨。

Eighteen adult patients were radomly divided into three groups. Group Ⅰ: epidural blockade with lidocaine 3.2 mg/kg, group Ⅱ: epidural blockade with the some dosage of lidocaine added with 1 : 200,000 adrenaline, and group Ⅲ intravenous administration of Lidocaine Img/kg. The plasma concentration of Lidocaine, changing against time was fitted into two-compartment open model of pharmacokinetics, and was eliminated at first order rate. The peak plasma concentration of lidocaine after epidural administration were 3.7±1.4 and 2. 6±0.6 μg/ml,peak time were 13.5±3.6 and 16.4±3.6 min, t1/2Ka were 2.901±1.305 and 3. 464±2.163 min , t 1/2βwere 148.158±41.298 and 167.82±34. 611 min. CL were 6.991±1.124 and 6.842±1. 82ml/kg/min, and V_C wereO.677±0.206 and 0.946±0.215 L/kg for group Ⅰ and group Ⅱrespectively. In group Ⅲ , Co was 3.3±0.8μg/ml, t1/2β was 104.541±50.23min, CL was 9.744±2.122 ml/kg/min, and V_C was 0.323±0.127 L/kg. With the principle and the equations of pharmacokinetics. the remedy of the Lidocaine antiarrhythmia during the lidocaine epidural blockade was discussed.