利多卡因局部浸润麻醉下周围动脉重建术在老年患者中的应用

Local infiltration anesthesia with lidocaine for revascularization of peripheral artery in elderly patients

目的探讨并发症少、并能为周围动脉重建术提供良好手术环境的可靠麻醉方法。方法 2004年12月～2010年6月,选择143例动脉造影诊断股浅动脉闭塞和13例髂动脉闭塞并伴有严重间歇性跛行或静息痛以及56例肾功能衰竭行血液透析治疗的患者,在0.22%利多卡因局部浸润麻醉下行周围动脉重建术,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,56例行上肢动静脉搭桥术。术前评定患者的美国麻醉师协会(ASA)分级及合并症。记录麻醉药用量、视觉模拟评分(VAS)及舒适评分(BCS)、围手术期并发症。并记录手术当日晨间、切皮时、手术开始后1h和手术结束时的平均动脉压(MAP)、心率(HR)和脉搏氧饱和度(SpO_2)。结果所有病例均顺利耐受手术,且术区环境良好,BCS评分(2.6±0 8),VAS评分(3.0±2.1),各时间点MAP,HR和SpO_2无明显变化。利多卡因(0.22%)用量350～487mg,平均用量417mg。本组病例围手术期死亡率为0,转流血管通畅率为97.16%(206/212)。结论利多卡因局部浸润麻醉能够为周围动脉重建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 method which has few complications and provides an adequate surgical environment for revascularization of peripheral artery.Methods From December 2004 to June 2010,212 patients were enrolled, including 143 patients with an occluded superficial femoral artery and 13 iliac artery occlusion diagnosed by angiography,and complicated with life style-limiting intermittent claudication or rest pain,and 56 patients with renal failure undergoing hemodialysis. Revascularization of peripheral artery was performed under local infiltration anesthesia with lidocaine（0.22%）,including 13 femoral-femoral,143 above knee femoral-popliteal bypass grafts,and 56 artery-vein bypass grafts.American Society of Anesthesiologists（ASA） grade and complications were evaluated preoperatively.Anesthetic dose,visual analogue scale（VAS）, Bruggrmann comfort scale（BCS）,and perioperative complications were recorded.Additionally,mean artery pressure（MAP）,heart rate（HR）,and saturation pulse oxygen（Sp02） in the morning,at incision,at 1 hour,and at the end of the operation,were also recorded. Results All patients tolerated the procedure well.The surgical environment was satisfactory.BCS was（2.6±0.8）.VAS was（3.0±2.1）. MAP,HR,and SpO_2 were not significantly different between different time points.The dosage of lidocaine（0.22%） was 350-487mg, mean 417mg.There was no perioperative death.Graft patency rate was 97.16%（206/212）.Conclusion Lidocaine local infiltration anesthesia could provide a satisfactory surgical environment for revascularization of peripheral artery.This technique is easy to perform and has few complications,especially is adaptable to high-risk and elderly patients.