气管内和静脉应用利多卡因预防小儿全麻气管内插管心血管反应的效果比较

Comparison of the Tracheal and Intravenous Lidocaine on Preventing Cardiovascular Response in the Children with General Anesthesia and Tracheal Intubation

目的:比较气管内及静脉应用利多卡因对小儿全麻气管插管时心血管反应的影响。方法:45例1～12岁的患儿被随机分成气管内组(T组)、静脉组(V组)及对照组(P组)。诱导时分别静脉推注异丙酚3mg.kg-1、芬太尼2μg.kg-1及万可松1.5mg.kg-1。T组和V组在插管前1.5min分别气管内喷雾和静注1.5mg.kg-1利多卡因。观察并记录患儿在诱导前、插管前1.5min、插管即刻、插管后1min、3min、5min的心率(HR)、收缩压(SBP)、舒张压(DBP)和平均动脉压(MAP)的变化。结果:插管即刻,除P组HR、DBP、MAP较基础有所上升外,其余各组数据未见明显变化,V组SBP甚至有所下降。V组的SBP、MAP则明显低于T组和P组。插管后1min,T组的血压与基础和插管前1.5min相比,均有明显的下降。插管后3min及5min,各组的血压和心率均可大致恢复到插管前水平。结论:气管内及静脉应用利多卡因均能减轻小儿气管插管时的心血管反应,而且静脉应用利多卡因使整个气管插管过程中心血管反应更加平稳。

Objective：To compare the clinical effects of the tracheal and intravenous lidocaine on preventing cardiovascular re sponse in the children with general anesthesia and tracheal intubation. Methods：Fourty-five children of 1 to 12 years old were randomly allocated into tracheal group （Group T） ,venous group （Group V） and contral group（ Group P）. Induction of anesthesia was commenced by intravenous administration of propofol 3 mg/kg,fentanyl 2μg/kg and vecuronium 1.5 mg/kg. Patients of group T were given lidocaine aerosol by trachea and patients of group V were given lidocaine 1.5 mg/kg i. v before intubation 1. 5 min. Change in heart rate （HR） ,systolic blood pressure （SBP） and diastolic blood pressure （DBP） were recorded before in duction of anesthesia, immediately intubation and at 1 ,3 and 5 min after intubation in all children. Results： There was no significant differences between 3 groups at immediately intubation with the exception of ascending HR, SBP, MAP in Group P（P〈 0.05）. Compared with other groups,SBP in Group V even decreased （P〈0.05）.SBP and MAP in Group V were obviously lower than those of other groups（P〈0.05）. The blood press in Group T decreased remarkably at 1 min after intubution compared with the baseline （P〈0.05）. There were no significant difference in 3 groups at 3 min and 5 min after intubution. Conclusion： Both tracheal lidocaine aerosol and intravenous lidoeaine can effectively prevent the cardiovascular response caused by tracheal intubation. Intravenous lidocaine can apply more stable hemodynamic status during endotracheal intubation.