利多卡因表面麻醉致中毒3例并文献复习

Three cases report of lidocaine intoxication caused by superficial anesthesia and literature review

目的总结利多卡因表面麻醉致中毒的临床特点。方法回顾性分析3例外用利多卡因乳膏导致中毒的患儿的临床资料,并进行文献复习。结果 3例患儿均表现为抽搐和高铁血红蛋白血症,其中1例有呼吸困难,1例为惊厥持续状态、呼吸抑制合并肺出血。所有患儿经治疗全部存活。外用利多卡因中毒表现与注射导致中毒相似,主要为神经系统和心血管系统症状。静脉应用脂肪乳剂应作为局麻药中毒所致严重心律失常的抢救措施。结论熟悉利多卡因中毒的表现,警惕中毒的可能性,中毒后及早诊断治疗是避免中毒、减轻中毒所致伤害的关键。

Objective To summarize the clinical features of lidocaine intoxication caused by superficial anesthesia. Methods The clinical data of 3 patients with lidocaine intoxication caused by superficial anesthesia with lidocaine cream were retrospectively analyzed, and the literatures were reviewed. Results All 3 patients had seizures and methemoglobinemia. One patient had dyspnea, one had convulsion status,respiratory depression and pulmonary hemorrhage.All 3 cases survived. The manifestations of lidocaine toxicity caused by superficial anesthesia were similar to those caused by injection, including central nervous system toxicity and cardiotoxicity. Intravenous lipid emulsion should be used as the rescue therapy for sever arrhythmia caused by local anesthetics intoxication. Conclusion Early diagnosis and treatment are the keys to avoid intoxication or reduce the damage of lidocaine toxicity.