静脉注射利多卡因对丙泊酚麻醉诱导的影响

The effect of intravenous lidocaine on propofol anesthesia induction

目的观察不同剂量利多卡因对丙泊酚麻醉诱导的影响。方法80例行全身麻醉结肠镜检查的患者，随机分为四组（n=20）：分别静注利多卡因1mg／kg（L1．0组）、1．5mg／kg（L1．5组）、2mg／kg（L2．0组）或0．9％生理盐水（对照组：C组）后，再静注丙泊酚10mg／15s，直至改良清醒镇静（oaa／s）评分为1-0分为止。记录麻醉诱导前后HR、MAP、spO2，各组丙泊酚总用量、麻醉诱导时间及不良反应。结果L1．0、L2．0组麻醉诱导后HR与基础值有统计学差异（P〈0．05），四组麻醉诱导后MAP与基础值比较均有显著差异（P〈0．01）。L1．5组和L2．0组丙泊酚用量及诱导时间与c组比较，差异均有统计学意义（P〈0．05）。Spearman相关系数分析提示静注不同剂量利多卡因与丙泊酚用量之间呈线性负相关关系（r=-0．600，P〈0．01）。发生注射痛的患者：c组有10例，L1．0组有2例，而L1．5组和L2．0组未发生。发生呼吸抑制：C组中有5例，L1．0、L2．0组各有2例，L1．5组有1例。发生低血压：C组有6例，L1．0组有2例，u．5组有1例。结论利多卡因2mg/kg联合丙泊酚用于麻醉诱导可增强丙泊酚镇静催眠效果，减少其用量和不良反应，且两者呈剂量一效应关系。

Objective To explore the effect of intravenous lidocaine combined with propofol in anesthesia induc- tion. Methods 80 adult patients undergoing elective colonoscopy under general anesthesia were divided into four groups with 20 cases in each group. Group L 1.0 received lidocaine 1 mg/kg intravenously iv, group L 1.5 re- ceived lidocaine 1.5 mg/kg iv, group L 2.0 received lidocaine 2 mg/kg iv, group L 2.5 received lidocaine 2.5 mg/kg and control group received 0. 9% normal saline. Each group was given 10 mg of propofol every 15 s until responsiveness MOAA/S scale 1 -0 cents. HR, MAP and SpO2 were recorded before injection test drug and after anesthesia induction. Total propofol doses and anesthesia induction time in each patient was recorded, as well as adverse responses. Results HR reduced significantly after induction in group L 1.0 and L 2.0 （ P 〈 0. 05 ）, MAP in four groups reduced significantly after induction （P 〈 0. 01 ）. The dose of propofol and induction time in group L 1.5 and L 2.0 compared with group C, the differece were statistically significant （ P 〈 0.05 ）. Spearman corre- lation coefficient analysis indicated a negative linear correlation between different doses of intravenous lidocaine and minimum induction dose of propofol （r = -0. 600,P 〈0. 01 ）. Injection pain was reported in ten cases in group C and two cases in group L 1.0, five cases in the group C, two cases in group L 1.0 and L 2.0,one case in group L 1.5 had reported respiratory depression. Six cases in the group C, two cases in group L 1.0, one case in group L 1.5 had reported hypotension. Conclusion Intravenous lidocaine 2 mg/kg combined with propofol for anes- thesia induction can strengthen effect of propofol＇ s sedative hypnotic, reduce it＇ s dosage and adverse reactions, and set up a dose - response relationship.