局麻药中加入肾上腺素在安置永久性人工心脏起搏器中的应用

The addition of epinephrine to local anesthetic during implantation of permanent cardiac pacemaker

目的对局麻药中加入适量肾上腺素在安置永久性人工心脏起搏器患者减少皮下囊袋出血和安全性方面的探讨。方法将40例行永久人工心脏起搏器植入的病人随机分为试验组和对照组,每组各20例。试验组予2%利多卡因40ml+肾上腺素5μg/ml局麻做皮下囊袋,对照组仍予2%利多卡因40ml局麻做皮下囊袋。比较两组病人皮下囊袋出血,及心率、血压的变化及室性心律失常和主观不适感的发生情况。结果①试验组无皮下囊袋出血,而对照组有4例囊袋出血。两组病人均无皮肤坏死,皮下囊袋感染及延迟愈合。②两组病人心率、血压、室性早搏、非持续性室速和主观不适感局麻前后无明显变化(P>0.05),两组病人均无持续性室速发生。结论局麻药中加入适量肾上腺素可减少安置永久性人工心脏起搏器患者的皮下囊袋出血,且对心率、血压、室性心律失常及主观不适感发生无明显影响,是安全可行的。

Objective To investigate the effect of addition of epinephrine to local anesthetic on bleeding in subcutaneous pocket during implantation of permanent cardiac pacemaker and its safety. Methods 40 adult patients undergoing permenant pacemaker implantation were randomly assigned into two groups. 20 patients were injected with 2% lidocaine 40 ml plus epinephrine 5 μg/ml and 20 patients were injected with 2% lidocaine 40 ml only at the operative site of subcutaneous pacemaker pocket after finishing temporary pacemaker insertion and subcavian vein puncture. Bleeding in subcutaneous pocket, heart rate （HR） , blood pressure （BP） , ventricular arrhythmia and malaise were compared between the two groups before and after anesthesia. Results ①There was no bleeding in subcutaneous pacemaker pocket in the test group patients; there were no skin necrosis, infection and delayed wound healing in two groups. ②There were no significant differences in HR, BP, ventricular premature beats, unsustained ventricular tachycardia and malaise between the two groups before and after anesthesia （ P 〉 0.05 ）. There was no sustained ventricular tachycardia in the two groups. Conclusion The addition of epinephrine to local anesthetic during implantation of permanent cardiac pacemaker is safe and can reduce bleeding with no detrimental effect on HR, BP, ventricular arrhythmia and malaise.