静脉注射利多卡因对2型糖尿病患者气管插管期心率变异性的影响

Changes in heart rate variability of patients with type 2 diabetes on intravenous lidocaine during intubation

目的 研究静脉注射利多卡因在全麻诱导气管插管期间对2型糖尿病患者自主神经系统功能的影响. 方法 70例择期腹部手术2型糖尿病患者,采用McLeod改良Wichmann-Hill伪随机数发器生成的随机序列.随机双盲分成利多卡因组（L组,诱导前静脉注射1.5 mg/kg利多卡因）和对照组（C组,诱导前静脉注射等容量氯化钠溶液）,每组35例,分别于麻醉诱导前（T0）、麻醉诱导后1 min（T1）、麻醉诱导后3 min（插管前,T2）及插管后1 min（T3）、6 min（T4）用心率（heart rate,HR）变异功率谱分析技术观察患者的心率变异性（heart rate variability,HRV）改变. 结果 与T0比较,T1～T2时,L组低频段（low frequency,LF）（233±131）、（219±98） ms2/Hz和总功率频段（total power,TP）（751±219）、（761±236） ms2/Hz,C组LF （296±99）、（279±103） ms2/Hz,高频段（high frequency,HF）（91±36）、（97±43） ms2/Hz,低频/高频比（LF/HF ratio,LF/HF）（1.8±0.7）、（1.9±0.6）及TP（759±197）、（751±213） ms2/Hz均显著降低（P＜0.05）,组间比较,L组LF低于C组（P＜0.05）,而L组HF高于C组（P＜0.05）；T3～T4,两组LF、HF及TP均较To显著升高（P＜0.05）,而L组的LF/HF较T0差异无统计意义,C组的LF/HF（6.0±1.8）、（5.9±1.9）较T0显著升高（P＜0.05）；组间比较L组LF、TP升高程度显著低于C组（P＜0.05）,HF组间差异无统计意义.与T0比较,T1～T2时,两组HR、收缩压（stolic blood pressure,SP）、舒张压（diastolic blood pressure,DP）均显著降低（P＜0.05）；组间比较,L组SP、DP降低程度显著高于C组（P＜0.05）,而两组间HR的改变差异无统计学意义.T3～T4,两组HR、SP、DP较麻醉诱导后均显著升高（P＜0.01）.组间比较L组HR、SP及DP升高程度显著低于C组（P＜0.05）. 结论 全麻诱导气管插管期间2型糖尿病患者对自主神经功能一定的干扰,静注利多卡因能明显抑制插管操作引起的对自主神经功能的干扰,有利于维护2型糖尿病患者围插管期心脏的自主神经调节功能.

Objective To explore effects of the autonomic nervous system function on Intravenous injection of lidocaine during intubation in patients with type 2 diabetes.Methods 70 patients undergoing abdominal surgery were randomly divided into lidocaine group （group L,n=35,with intravenous 1.5 mg/kg lidocaine） and control group （group C,n=35,with intravenous sodium chloride solution）,The changes in heart rate variability （HRV） were recorded at following time points：prior to anesthesia （T0）,1 min after anesthesia induction （T1）,3 min after anesthesia induction and prior to intubation （T2）,1 min after intubation （T3）,the HRV was observed with power spectral analysis.Results After induction of anesthesia （T1,T2）,group L of low-frequency（LF）（233±131）,（219±98） ms2/Hz,and total power of HRV spectrum（TP）（751±219）,（761±236） ms2/Hz,group C of LF（296±99）,（279± 103） ms2/Hz,high frequency （HF） （91 ±36）,（97±43） ms2/Hz,low frequency/high frequency ratio （LF/HF） （1.8±0.7,1.9±0.6） and TP （759±197）,（751±213） ms2/Hz were significantly lower than T0,inter-group comparison group L LF lower than group C; but HF higher than group C.After intubation （T3,T4）,two groups of LF,HF and TP were significantly higher than T0 （P〈0.05）,D group of LF/HF were not significantly higher than T0,however,group C of LF/HF （6.0±1.8,5.9±1.9） were significantly higher than T0 （P〈0.05）,inter-group comparison GroupL with LF,TP increased significantly lower than the groupC （P〈0.05）,HF inter-group difference was not significant.After induction of anesthesia （T1,T2）,both groups of HR,SP,DP lower than T0.inter-group comparison group L SP,DP lower than group C; HR inter-group difference was not significant.After intubation （T3,T4）,two groups of HR,SP,DP were significantly higher than T0 （P〈0.05）,inter-group comparison group L H R,SP,DP lower than group C （P〈0.05）.Conclusions autonomic nervous system function changed following tracheal intubation during induction of anesthesia in patients with type 2 diabetes,Intravenous lidocaine inhibit those changes.This is beneficial to maintain cardiac autonomic nerve function in patients with coronary artery disease during intubation.