扁桃体手术局麻药中毒的研究

Analysis of Systemic Toxicity Resulted from Local Anesthetics in Tonsillectomy

扁桃体切除术普遍用局麻，少数病人在注射局麻药时突然发生意识丧失、惊厥、紫绀、呼吸停止、血压下降、甚至心跳停止而死亡等严重并发症。我们认为是中毒反应。在家兔身上所作毒力试验显示，同等剂量１％利多卡因在咽部粘膜与静脉注射各时间点血药浓度比较，血药浓度采用荧光偏振免疫法（ＦＰＬＡ）方法测定，在统计学上无明显差异（Ｐ＞００５）。说明麻药在血管丰富粘膜可被迅速吸收或可能麻药误入血管，瞬间麻药进入血液循环，超过机体的消除速率，麻药立即以很高血药浓度到达心脏和脑组织。

Unconsciousness,convulsion,cyanosis,apnea,drop of blood pressure,cardiac arrest may occur in some patients during the anesthetic injection in tonsillectomy.This complication was once regarded as primary shock,but with no conclusion.We consided it a toxic reaction.We gave same dose of 1% lidocain injection in different location of the rabbit.The lidocain concentration was measured with FPLA method.The comparison of concentration showed no statistical difference(P>005) between intravenous and pharyngeal mucosa injection.It suggested that the anesthetic was absorbed rapidly in mucosa of abundant blood vessels or might be injected into the carotis.Too much lidocain entered blood circulation rapidly,the body couldn't eliminate it at once,high concentration lidocain reached brain and heart,so systemic toxication occured.