利多卡因气管内注药对腹腔镜手术患者眼内压的影响

Effects of endotracheal lidocaine on intraocular pressure in patients with laparoscopy

目的观察利多卡因气管内注药对腹腔镜手术患者眼内压的影响。方法选择美国麻醉医师协会麻醉分级（ASA）Ⅰ-Ⅱ级、无眼部疾患的80例腹腔镜胆囊切除手术患者，随机分为利多卡因组（L组）和对照组（C组），每组各40例。L组患者麻醉诱导后在气管内喷注2％利多卡因2ml，C组患者给予等量生理盐水。记录麻醉诱导前（T0），诱导后3分钟（T1），气管插管后1分钟（T2），二氧化碳（CO2）气腹后10分钟（T3），气腹后30分钟（T4），气腹结束后10分钟（T5）不同时间点患者的眼内压（IOP）、平均动脉压（MAP）、心率（HR）及呼气末二氧化碳分压P ET CO2的变化。结果与T0时比较，T1时两组IOP、MAP及HR明显降低。与T1时比较，T2～T4时两组IOP、MAP和HR明显升高（P〈0．05）。但L组T2-T4时IOP、MAP和HR升高幅度均明显低于C组（P〈0．05）。术中两组患者P ET CO2均在正常范围，两组比较差异无统计学意义（P〉0．05）。结论麻醉诱导后气管内注入利多卡因可有效减轻腹腔镜手术患者气管插管后和气腹后所致的IOP升高。

Objective To investigate the effects of intratracheal administration of lidocaine on intraocular pressure in patients with laparoscopic surgery. Methods Eighty ASA grade Ⅰ - Ⅱ patients without eye diseases were selected for laparoscopic cholecystectomy and randomly divided into two groups ：the lidocaine group（ Group L）and control group（ Group C） ,with 40 patients in each group. Patients in Group L were intratracheally administered with 2 ml of 2% lidocaine after anesthesia induction. Patients in Group C were treated with equal volumes of normal saline. The intraocular pressure （ IOP）, mean arterial pressure （MAP）, heart rate（HR） and end-tidal carbon dioxide partial pressure（ PET CO2 ）were monitored at indicated time points ： right before induction of anesthesia（ T0 ） ,3 min after induction （ T1 ）, 1 min after intubation （T2 ）, 10 min and 30 min after carbon dioxide （CO2 ）pneumoperitoneum（ T3 and T4 ）, and 10 min after pneumoperitoneum （ T5 ）. Results Compared with To, the value of IOP, MAP and HR at T1 were dramatically decreased in Group L and Group C. Although the values at T2, T3 and T4 were increased in both groups compared with those at T1 （P 〈 0.05 ）, the increased extent of Group L was lower than that of the Group C（ P 〈0.05 ）. Based on the PETCO2 value,it located in the normal range and there was no significant difference between the two groups. Conclusion Lidocaine administration in tracheal after anesthesia induction can effectively reduce IOP elevation resulted from the intubation and pneumoperitoneum in patients with laparoscopic surgery.