中长链脂肪乳救治局部麻醉药物神经系统急性毒性反应1例

Employment of lipid emulsion in the resuscitation for local anesthetics toxicity of central nervous system

局部麻醉药物全身急性毒性反应（local anesthetic systemic toxicity,LAST）是局部麻醉的严重并发症之一.综合措施预防LAST的发生非常关键,恰当、准确、及时的LAST救治至关重要,可最大程度地降低其危害.现报道1例ASA分级Ⅰ级男性患者,接受罗哌卡因连续硬膜外麻醉后出现LAST,主要表现为口周麻木、耳鸣、头晕及头部非自主性抽搐等中枢神经系统症状,镇静效果不佳,给予20％中长链脂肪乳注射液（medium-long chain triglycerides lipid emulsion,MLE）100ml泵注后患者抽搐消失,后痊愈出院.美国局部麻醉协会指南推荐,发生LAST时应尽早使用脂肪乳剂,避免LAST的发展.

Local anesthetic systemic toxicity （LAST） is a serious complication of local anesthesia.Comprehensive measurement to prevent LAST is very critical.Treatment of LAST exactly and timely is very important which can reduce the harm to patients.Now we reported a case of male patient with ASA Ⅰ who accepted continuous epidural anesthesia and appeared LAST with symptoms of central nervous system.With sedative-hypnotic drug the patient acted not so ideal.Then 100 ml of 20% medium-long chain triglycerides lipid emulsion（MLE） was injected.After that,this patient recovered well.The American society of regional anesthesia guidelines recommended that LE should be used as soon as possible when the LAST happened to avoid the development of the LAST.