利多卡因在老年患者腹腔镜胆囊摘除术麻醉中的应用

Use of Lidocaine in Anesthesia for Laparoscopic Cholecystectomy in Elderly Patients

目的:观察利多卡因静脉应用对腹腔镜胆囊摘除术老年病人血流动力学的影响,并了解其麻醉效果.方法:将58例择期行腹腔镜胆囊摘除术的病人,随机分为实验组(n=29)和对照组(n=29),均选用气管内插管,静吸复合全麻.实验组在气管内插管前60 s静脉注射利多卡因1～1.5 mg/kg,插管后即用微量泵静注利多卡因2mg·kg-1·h-1 .对照组,除不用利多卡因外,余用药与实验组相同.观察麻醉前、诱导后、插管后即刻、术中及拔管前血压及心率变化;拔管时呛咳发生率及术毕拔管时间和清醒时间.结果:实验组在插管后、术中及拔管前血压及心率变化较对照组小,组间比较有显著性差异(P＜0.05);拔管时呛咳发生率,两组间有显著性差异(P＜0.05);拔管时间及清醒时间,两组间无显著性差异(P＞0.05).结论:利多卡因静脉复合全麻,具有麻醉效果确切,心血管应激反应小,循环变化轻,不影响术毕苏醒等优点,可作为老年患者腹腔镜胆囊切除术的一种较好的麻醉方法.

Objective To investigate the effect of intravenous injection of lidocaine on the hemodynamics of elderly patients undergoing laparoscopic cholecystectomy and to assess its anesthetic efficacy.Methods Fifty-eight patients undergoing laparoscopic cholecystectomy were randomly divided into two groups(n=29): the experimental group and control group,all receiving intratracheal intubation and combined intravenous with inhalation general anesthesia.In the experimental group,lidocaine was injected intravenously in 1~1.5mg/kg 60 seconds before intubation and continuously in 2 mg·kg -1·h -1 by micro pump immediately after intubation.In the control group,the same drugs were administered as in the experimental group except no lidocaine was injected.Blood pressure (BP) and heart rate (HR) were observed at the time of pre-anesthesia,post-induction,immediate post-intubation,intra-operation and pre- removal of intubation.The bucking incidence when removing intubation and the intubation removal time and awake time were measured.Results The changes of BP and HR in the experimental group were less than in the control group at the time of post-induction,immediate post-intubation, intra-operation and pre- removal of intubation(P<0.05).There was significant differene in the bucking incidence between the two groups(P<0.05). There was no significant differene in the intubation removal time and awake time between the two groups(P>0.05).Conclusions Lidocaine intravenous combined anesthesia is one of the better methods for laparoscopic cholecystectomy in elderly patients with the advantage of reliable anesthetic efficacy,less cardiovascular stress and no influence on awake time.