利多卡因对预防异丙酚注射痛及对血浆内皮素水平的影响

The Clinical Observation of Lidocaine in the Prevention of Pain on Injection of Propofol and the Effect of Lidocaine on Level of Plasma Endothelin-1

目的探讨麻醉诱导期间利多卡因浓度对减轻异丙酚注射痛及血浆内皮素水平的影响。方法选择42例冠心病择期行冠状动脉旁路移植术患者,随机分为 A、B 两组,A 组应用微机控制靶控输注异丙酚,逐渐增加异丙酚目标浓度直至意识消失;B 组在 A 的基础上同时以输液泵持续输注利多卡因4.0μg·ml^(-1)。于术前(T_1)、术中1 h(T_2)、术毕停药时(T_3)及术后24 h(T_4)抽取静脉血2 ml 测定血浆内皮素-1(ET-1)浓度;记录患者疼痛程度。结果合用利多卡因组 B 组疼痛发生率低于单用异丙酚组 A 组(P<0.05);两组患者术中1 h(T_2)、术毕停药时(T_3)血浆内皮素水平均较术前(T_1)升高(P<0.05),至 T_4时 A 组 ET-1水平已有所回降,但仍较 T_1高,而 B 组则已恢复至术前水平。B 组 T_2、T_3、T_4血浆内皮素浓度均低于 A 组(P<0.05)。结论 4μg·ml^(-1)利多卡因持续静脉输注可有效预防异丙酚注射弓I起的局部痛,二者联合应用可降低术中及术后血浆内皮素水平,可降低围手术期并发症的发生。

Objective To observe the effect of Lidocaine pretreatment during the period of anesthesia induction to prevent the pain on injection of Propofol in patients undergoing coronary bypass grafting（CABG） and to explore the effect of Lidocaine pretreatment on level of plasma Endothelin - 1 （ ET - 1 ）. Methods 42 patients undergoing CABG were randomly divided into two groups. Patients in group A were anesthetized by Propofol and patients in group B were anesthetized in combination with Lidocaine. The level of plasma ET - 1 before operation （ T1 ）, in the operation （ T2 ）, at the end of operation （ T3 ） and 24h after operation （T4） were detected and the operative outcomes were observed. The patients were asked if they were comfortable during anesthesia and the severity of pain was recorded. Results The incidence of pain in group B was lower than that in group A （ P 〈 0. 05 ）. There were no significant differences in operative outcomes between the two groups. In both groups, the levels of ET - 1 in T2 and T3 were higher than that in T1. The levels of ET - 1 in group A were dropped in T4 but were higher than that in T1, whereas they were dropped to the preoperative levels in group B. Zn B group the levels of ET - 1 in T2,T3 and T4 In B group were lower compared with A group. Conclusion In patients undergoing CABG,eontinuous intravenous infusion of lidoeaine could prevent the pain on injection of propefol more effectively. Besides, anesthesia using lidocaine and propofol could decrease the plasma level of ET - 1 in the operation and reduce the peri - operative complications.