不同浓度利多卡因对婴儿骶管阻滞神经毒性的临床观察

Neural toxicity of Lidocaine in infant caudal block

目的通过应用不同浓度的利多卡因对1～3个月的婴儿进行骶管阻滞,观察不同浓度利多卡因的安全性及有效性。方法选择2009-2012年于广州市妇女儿童医疗中心因双侧马蹄足需行跟腱切断术的90例婴儿作为研究对象,采用随机数字法分为A、B、C组,分别用0.5%、1%、1.5%利多卡因行骶管阻滞麻醉。观察骶管阻滞前(T1)、骶管阻滞后10min(T2)、切皮时(T3)、术毕时(T4)各时点心率(HR)、收缩压(SBP)、舒张压(DBP)、呼吸频率(RR)、心电图(ECG)变化及术后4、8h患儿对疼痛刺激的反应。结果切皮时,A组与B、C组比较HR、SBP、DBP、RR差异有统计学意义(P<0.05),其余各时间点各组间比较无统计学意义(P>0.05),三组中ECG也未发现有异常改变,术后4、8h后双侧足趾疼痛刺激时双髋屈曲反应正常。A组患儿在切皮时有6例因体动需要静脉追加氯胺酮。结论 0.5%～1.5%利多卡因用于婴儿骶管阻滞安全有效,其中1%利多卡因更适合。

Objective To evaluate the efficacy and safety of lidocaine in infant caudal block. Methods Between 2009 and 2012,90 strephopodia cases of patients from the Guangzhou Women and Children＇s Medical Center receiving achillotomy were selected for this study. The patients were randomly divided into 3 groups. Patients in group A, group B, and group C were given with lidoeaine 0.5%, 1%, and 1.5%, respectively. The changes of heart rate（HR）, systolic blood pressure （SBP）, diastolic blood pressure （DBP）, respiratory rate （RR） and ECG were recorded before and after the surgery. The response to sharp pain was evaluated at 4 to 8 hours after the surgery. Results There was no difference in HR, SBP, DBP and ECG. The contraction of hip joint by sharp pain was normal （P〉0.05）. There was a difference at skin incision between group A and group B, C （P〈0.05）. There were 6 cases remedied ketamine for body movement at skin incision in group A. Conclusions Lidocaine （0.5% to 1.5%） is safe for use in infant caudal block. 1% Lidocaine is more suitable to use in infant caudal block.