低浓度利多卡因局部浸润麻醉下下肢动脉重建术

Local Infiltration Anesthesia with Lidocaine for Revascularization in the Lower Extremity

目的探讨麻醉可靠、并发症少,并能为下肢动脉搭桥术提供良好手术环境的麻醉方法。方法2004年12月~2009年5月,选择143例动脉造影诊断股浅动脉闭塞和13例髂动脉闭塞合并严重间歇性跛行或静息痛,在0.22%利多卡因局部浸润麻醉下行下肢动脉旁路移植术,其中13例行耻骨上人工血管转流术,143例行股-腘动脉旁路移植术。记录麻醉药用量、VAS及BCS评分、围手术期并发症,手术当日晨间、切皮时、手术开始后1 h时和手术结束时的平均动脉压（meanarterial pressure,MAP）、心率（heart rate,HR）和SpO2。结果所有病例均顺利耐受手术,且术区环境良好,舒适评分（bruggramann comfort scale,BCS）（2.6±0.8）分,VAS评分（3.0±2.1）分,各时间点MAP、HR无明显变化[（97.4±10.1）,（97.5±10.5）,（97.9±13）,（97.3±10.8）mm Hg,F=0.05,P=0.987;（89±24）,（91±20）,（87±22）,（89±22）次/min,F=0.44,P=0.721;SpO2各对点虽有统计学差异（P〈0.05）,但无临床意义。利多卡因（0.22%）用量350~482 mg,平均416mg。本组围手术期死亡率为0,转流血管通畅率为98.7%（154/156）。结论利多卡因局部浸润麻醉能够为下肢动脉搭桥手术提供良好的麻醉效果,操作简单,并发症少,尤其适用于高危、高龄患者。

Objective To investigate an ideal anesthetic approach with few complications and providing adequate surgical environment.Methods From December 2004 to May 2009,143 patients with an occluded superficial femoral artery and 13 patients with intermittent claudication or rest pain due to iliac artery occlusion,who were diagnosed by angiography,were enrolled in this study.Lidocaine（0.22%） local infiltration anesthesia was employed during femoral-femoral or knee femoral-popliteal bypass grafting.The dosage of lidocaine,VAS and BCS scores,peri-operative complications,and the mean arterial pressure（MAP）,heart rate（HR）,and SpO2 determined in the morning of the operational day,at the skin incision making,1 hour after the operation initiation,and at the end of the surgery were recorded.Results All the patients tolerated the procedure well.The mean VAS and BCS scores of the patients were 3.0±2.1 and 2.6±0.8 respectively.No significant differences were detected in the MAP and HR at different time points [（97.4±10.1）,（97.5±10.5）,（97.9±13）,（97.3±10.8） mm Hg,F=0.05,P=0.987;and（89±24）,（91±20）,（87±22）,（89±22）/min,F=0.44,P=0.721,respectively].There existed significant difference in SpO2 among different time points,however,the difference showed no clinical significance（P0.05）.The dosage of lidocaine used was 350 to 482 mg with a mean of 416 mg.The peri-operative death rate of this series of patients was 0,and the rate of graft patency was 98.7%（154/156）.Conclusions Local infiltration of lidocaine provides a good perioperative analgesia and satisfactory surgical environment for artery bypass grafting in the lower extremity.This technique is easy to be performed with less complication of anesthesia;it is feasible especially for high-risk and elderly patients.