单次静脉注射利多卡因血药浓度的测定

Detection of plasma concentrations of single intravenous lidocaine

目的 探讨单次静脉注射利多卡因血药浓度变化趋势,为临床用药提供参考.方法 40例择期行全麻开胸手术患者,入室后常规监测生命体征,开放静脉通道.静注咪达唑仑0.04 mg/kg、舒芬太尼0.3 μg/kg、丙泊酚2 mg/kg、罗库溴铵0.6 mg/kg诱导,然后行气管插管机械通气,桡动脉穿刺置管测动脉压.将患者随机分为四组（n=10）：分别静注利多卡因1 mg/kg（L1.0组）、1.5 mg/kg（L1.5组）、2 mg/kg（L2.0组）、2.5 mg/kg（L2.5组）,注射时间30 s,注射完成后于分别于1min（T1）、2min（T2）、3min（T3）、5min（T5）抽取动脉血3mL供测定血浆利多卡因浓度用,同时记录静注利多卡因前后HR、MAP和心电图.结果 4组病人的年龄差异有统计学意义（P＜0.05）,静脉注射利多卡因前后HR、MAP均无统计学差异（P＞0.05）.L2.0组1 min时利多卡因血药浓度大于5μg/mL,L2.5组T1、T2、T3血药浓度均大于5μg/mL.结论 单次静脉注射利多卡因1 ～ 1.5 mg/kg各时间点血药浓度均在安全范围内,静注利多卡因2.0 mg/kg可能存在风险,使用时应减慢注射速度,不推荐单次注射2.5 mg/kg剂量.

Objective To explore the plasma concentrations variation trend of single intravenous lidocaine and provide reference for clinical drug use. Methods The electrocardiograph monitoring of 40 patients scheduled to undergo elective thoracotomy under general anesthesia and the vein channel Was opened. Patients were intrave- nously given midazolam （0.04 mg/kg）, sufentanil （0.3μg/kg）, propofol （2 mg/kg）, rocuronium （0.6 mg/ kg） followed by the trachea intubation and mechanical ventilation, the radial artery puncture to place the catheter arterial and the measurement of arterial pressure. Patients were randomly divided into four groups with 10 cases each： group L1.0 （received 1.0 mg/kg lidocaine i. v）, group L1. 5 （received 1.5 mg/kg lidocaine i. v）, group L2.0 （received 2mg/kg lidocaine i. v） , group L2.5 （received 2.5mg,/kg lidocaine）. The lidocaine injection time was 30s and then 3ml arterial blood was extracted 1 min （ T1 ）, 2min （ T2）, 3min （ T3 ） and 5min （ T5 ） af- ter injection to detect the plasma licocaine concentration with gas chromatography - mass spectrum technology. HR, MAP and electrocardiogram were recorded before and after intravenous injection of lidocaine. Results There was significant difference of patient age among 4 groups （P 〈 0.05 ）. No significant difference of HR and MAP before and after intravenous injection of lidoeaine was shown （ P 〉 0.05 ）. The plasma lidocaine concentrations of group L2.0 in T1 was more than 5 μg/ml, while the plasma concentrations of group L2.5 in T1, T2 and T3 was more than 5 μg/ml. Conclusion The plasma concentrations of single intravenous injection of lidocaine（ 1.0 -1. 5 mg/kg） at each time point are within the scope of security. There might be a risk of intravenous administration of lidoeaine （2.0 mg/kg）, suggesting that the injection speed was slowed down. Single injection of lidocaine （2.5 mg/kg） is not recommended.