肾上腺素联合利多卡因局部浸润麻醉对鼻内窥镜全麻手术患者的血液动力学影响

Effects of local infiltration anesthesia with epinephrine and lidocaine on hemodynamics parameters in patients undergoing endoscopic sinus surgery

目的了解肾上腺素联合利多卡因局部浸润麻醉对鼻内窥镜全麻手术患者的血液动力学影响,为肾上腺素的合理使用提供临床研究数据。方法 173例鼻内窥镜全麻手术患者被随机分为A组55例、B组66例和C组(对照组)52例。局部浸润麻醉方法:给予A组利多卡因联合肾上腺素20μg;给予B组利多卡因联合肾上腺素40μg;给予C组利多卡因。监测3组在浸润麻醉前以及浸润麻醉后1、1.5、2、3、4、6 min时的心率(HR)、平均动脉压(MAP)、心脏指数(CI)、加速度指数(ACI)。结果浸润麻醉后1.5、2 min时A组、B组的HR上升,MAP下降(均P<0.05);浸润麻醉后3 min时B组的HR上升(均P<0.05);与A组相比,浸润麻醉后1.5、2 min时B组的HR上升、MAP下降程度更大(均P<0.05)。浸润麻醉后1.5、2、3、4、6 min时A组、B组的CI、ACI均上升(均P<0.05);与A组相比,浸润麻醉后1.5、2、3、4、6 min时B组的CI、ACI上升程度更大(均P<0.05)。结论肾上腺素联合利多卡因局部浸润麻醉对鼻内窥镜全麻手术患者的血液动力学会产生一定影响,且影响程度与肾上腺素的剂量有关,推荐临床使用20μg肾上腺素。

Objective To explore the effects of local infiltration anesthesia with epinephrine and lidocaine on hemodynamics parameters in patients undergoing endoscopic sinus surgery; and to provide clinical data for the rational use of epinephrine. Methods Total 173 patients undergoing endoscopic sinus surgery were randomly divided into group A（ n = 55）,group B（ n = 66） and group C（ n = 52,control group）. Local infiltration anesthesia method： group A was given lidocaine combined with 20 μg epinephrine; group B was given lidocaine and 40 μg epinephrine; group C was given lidocaine. The heart rate（ HR）,mean arterial pressure（ MAP）,cardiac index（ CI）,and acceleration index（ ACI） in all three groups were measured before anesthesia and 1,1. 5,2,3,4,6 min after infiltration anesthesia,respectively. Results At 1. 5 and 2 min after infiltration anesthesia,HR increased in group A and group B,and MAP decreased（ P〈0. 05）; At 3 min after infiltration anesthesia,HR increased in group B（ P〈0. 05）; Compared with group A,HR and MAP decreased significantly in group B at 1. 5 and 2 min after infiltration anesthesia（ P〈0. 05）. The CI and ACI of group A and group B were increased at 1. 5,2,3 and 4 min after infiltration anesthesia（ P〈0. 05）; Compared with group A,the CI and ACI of group B increased significantly at 1. 5,2,3 and 6 min after infiltration anesthesia,respectively（ P〈0. 05）. Conclusion Local infiltration anesthesia with epinephrine combined lidocaine has effect on hemodynamics in patients undergoing endoscopic sinus surgery; the degree of influence is related to the dose of epinephrine,and 20 μg epinephrine is recommended.