静脉与气管内利多卡因减少气道刺激性心血管反应的比较

Comparision of Reducing the CVRs to Airway Stimulation between Intravenous Lidocaine and Intratracheal Lidocaine

目的 比较静脉利多卡因和气管内利多卡因减少气道刺激性心血管反应的效果。方法 选择期手术病人 40例 ,随机分为 2组 ,每组 2 0例 ,Ⅰ组为气管内利多卡因组 ,Ⅱ组为静脉利多卡因组。全麻诱导平稳后 ,用消毒导尿管插入气管导管内刺激气道粘膜 ,停止刺激后 ,两组分别从气管内和静脉给利多卡因 ,再用同样方法刺激气道。两组分别于诱导平稳后 (基础值 ) ,第 1次刺激时 ,停刺激后 2min ,给利多卡因后 5min ,第 2次刺激时 ,停刺激后 2min ,记录HR、MAP、SPO2 。结果给利多卡因前刺激气道时 ,两组MAP、HR显著高于基础值 (P <0 0 1)。给利多卡因后再次刺激气道时 ,Ⅰ组MAP、HR与基础值比无明显差别 (P >0 0 5 ) ,Ⅱ组MAP与基础值比也无明显差别 ( P >0 0 5 ) ,Ⅱ组HR仍高于基础值 ( P <0 0 5 )。两组的HR也有明显差别 ( P <0 0 5 )。结论 抑制气道机械刺激引起的心血管反应 ,气管内应用利多卡因效果比静脉应用利多卡因更好。

Objective To compare the effect of intravenous lidocaine and intratracheal lidocaine on reducing cardiovascular responses(CVRs) to airway stimulation. Methods Forty patients scheduled for selective surgery were randomly divided into two groups: groupⅠ(n=20,receiving intratracheal lidocaine); groupⅡ(n=20, receiving intravenous lidocaine). After general anesthesia induction, a sterile urinary drainage tube was inserted into tracheal catheter to stimulate mucosa of airway. After the stimulation stopped, lidocaine were given by trachea(groupⅠ) and vein(groupⅡ) respectively, then the same stimulation was repeated. HR, MAP and SPO 2 were recorded during anesthesia induction, at the first stimulation, 2 min after the first stimulation, 5 min after given lidocaine and 2 min after the second stimulation respectively. Results MAP and HR in both groups before given lidocaine were significantly higher than those after the induction (P<0 01). After given lidocaine MAP and HR in groupⅠ had not significant difference compared with those after the induction (P>0 05). MAP in groupⅡ had also not significant difference compared with that after the induction (P>0 05), but HR was significantly higher (P<0 05) and there was significant difference in HR between the two groups (P<0 05). Conclusions The effect of intratracheal lidocaine on inhibiting CVRs to airway stimulation is better than that of intravenous lidocaine.