麻醉诱导期间异丙酚与利多卡因的相互作用

Pharmacodynamic interaction between propofol and lidocaine during anesthesia induction

目的 探讨麻醉诱导期间不同利多卡因浓度对睫毛反射、意识消失时异丙酚血药浓度和心血管系统的影响。方法 选择 38例择期手术病人应用微机控制靶控输注利多卡因维持不同目标浓度 (Ct) ,其后从另一接口输注异丙酚 ,逐渐增加异丙酚目标浓度直至意识消失。根据利多卡因目标浓度将病人分为 5组 ,分别为A组 0 μg·ml- 1 (9例 )、B组 1 2 5 μg·ml- 1 (7例 )、C组 2 5 0 μg·ml- 1 (7例 )、D组 5 0 μg·ml- 1 (8例 )和E组 7 0 μg·ml- 1 (7例 ) ,采用高效液相色谱法测定血浆利多卡因、异丙酚浓度。结果 单用异丙酚时 5 0 %病人睫毛反射、意识消失血药浓度 (Cp5 0 )分别为 1 78μg·ml- 1 、3 17μg·ml- 1 。利多卡因血药浓度 1 2 5～ 4 3μg·ml- 1 时 ,睫毛反射消失时所需异丙酚Cp5 0降低明显约 42 1% ,浓度再增加则变化不明显。利多卡因浓度低于 7μg·ml- 1 时 ,利多卡因浓度增高则意识消失时异丙酚Cp5 0下降 ,两者呈线性关系 (r =- 0 6 9)。 结论 国人 5 0 %病人异丙酚睫毛反射、意识消失时浓度 (Cp5 0 )低于国外报道的水平 ,利多卡因能增强异丙酚镇静、催眠作用 ,临床应用以利多卡因血药浓度 4μg·ml- 1 为宜。

Objective To study the influence of lidocaine on the propofol concentration effect relationships for loss of eyelash reflex and loss of consciousness,hemodynamic function Methods Thirty eight patients were randomly allocated to receiving a computer controlled infusion of lidocaine at target concentration of 0μg·ml -1 (group A,n=9),1 25μg·ml -1 (group B,n=7), 2 5μg·ml -1 (group C,n=7), 5μg·ml -1 (group D,n=8),or 7μg·ml -1 (group E,n=7) respectively While the target concentration of lidocaine was kept stable, propofol was administrated with a computer controlled infusion at an initial target concentration of 0 5 1μg·ml -1 , which was increased every time by 0 5μg·ml -1 until loss of consciousness Plasma concentrations of lidocaine and propofol were measured with high performance liquid chromatography Results 50% of patients lost eyelash reflex and consciousness at plasma propofol concentrations(Cp50) of 1 78 and 3 17μg·ml -1 in the absence of lidocaine In the presence of plasma lidocaine concentration of 1 25 4 3 μg·ml -1 ,the Cp50 for loss of eyelash reflex was reduced by 42 1% There was a linear regression relationship between plasma lidocaine concentrations from 0 to 7μg·ml -1 and the Cp50 for loss of consciousness (r=-0 69 ) Conclusions The Chinese Cp50 for loss of eyelash reflex and consciousness are lower than those reported abroad Plasma lidocaine concentration at 4μg·ml -1 can potentiate properly the potency of propofol on the sedation and hypnosis during anesthesia induction