吸入利多卡因治疗支气管哮喘的可行性探讨

Effect of single dose inhaled lidocaine on the function of lung ventilation in asthmatics

目的 通过观察原有治疗基础上单次吸入一定剂量利多卡因对支气管哮喘患者第 1秒用力呼气量 (FEV1 )和峰值呼气流速 (PEF)的影响 ,探讨吸入利多卡因治疗支气管哮喘的可行性。方法 对 2 0例非急性发作期哮喘患者维持原治疗方案不变 ,分两次随机、双盲雾化吸入 5ml生理盐水和 5ml2 %利多卡因 ( 10 0mg) ,分别测定雾化吸入前 (基础值 )和吸入后 5、10、2 0、3 0、45、60min时的FEV1 和PEF。结果 雾化吸入NS和利多卡因后 10min内平均FEV1 和PEF均较基础值轻度下降 ,平均改变率 ( %基础值 )在不同处理因素间比较差异均无显著性。吸入利多卡因 45～ 60min后FEV1 和PEF有较大幅度升高 ,最高改变率 ( x±s)分别为 ( 6.2± 6.2 ) %和 ( 5 .8± 3 .8) %,而吸入NS后仅略有升高 ,两者比较差异有非常显著性 (P均 <0 .0 1)。吸入利多卡因后 45 %患者FEV1 、PEF升高 >7%,其发生率与吸入生理盐水比较差异有非常显著性 (P <0 .0 1)。结论 哮喘患者在原有治疗基础上吸入利多卡因安全可行 ,多数仅在吸入后早期出现短暂而轻度的FEV1 、PEF下降 ,2 0～ 60min后FEV1 。

Objective To observe the effect of single dose of inhaled lidocaine on forced expiratory volume at one second (FEV 1) and peak expiratory flow (PEF) in asthmatics with their current medications maintained, thereby discuss whether inhaled lidocaine is likely to serve as a routine treatment.Methods A randomized, double blind, placebo controlled study was performed in 20 asthmatics cases without current flares, medications of all patients were maintained. Each patient received 5ml of normal saline or 100 mg of lidocaine (2%, 5ml) administered as aerosols from a nebulizer. FEV 1 and PEF were determined before inhalation (as baselines) and at 5,10,20,30,45,60 min after nebulization.Results There was a transient fall in mean FEV 1 and mean PEF after the inhalation of both NS and lidocaine; the difference of mean percentage change (%baseline) was not significant between the two treatments 5～10?min after inhalation. The mean (±s) increase of FEV 1 and PEF was as high as (6.2±6.2)% and (5.8±3.8)% 45～60?min following lidocaine, but the increase was slight following normal saline, and difference was significant between the two treatments at 20～60min after inhalation ( P <0.01). About 45% of subjects experienced the increases in FEV 1 and PEF more than 7% of baseline following lidocaine inhalation while few showed such increases following NS inhalation( P <0.01). The incidence of adverse reaction was 15%.Conclusions Inhalation of 100mg lidocaine by nebulizer in asthmatics with their medications maintained caused a transient slihgt fall in FEV 1 and PEF in the majority of the subjects. FEV 1 and PEF showed obvious improvement 20～60 min after inhalation of lidocaine.