甲状腺切除术中泵入利多卡因对心率及甲状腺素分泌的影响

Study on the effects of lidocaine on the heart rate control and the excretion of thyroxine during thyroidectomy in patients with hyperthyroidism

目的 观察甲状腺功能亢进症 (甲亢 )手术中泵入利多卡因对术中心率增快的控制效果和对甲状腺素分泌变化的影响。方法 4 9例全麻下行甲状腺大部切除术的甲亢病人 ,随机分成两组 ,利多卡因组 (A组n =2 7) ,对照组 (B组n =2 2 )。A组于手术开始后 ,用微量泵输注利多卡因 10～ 2 0ml/h(80mg/ 10ml) ,若心率高于 10 0次 /分钟 ,增大利多卡因的泵入速度至 2 0～ 4 0ml/h。B组为全麻对照组。结果 两组切除甲状腺过程中的最高心率均较诱导前增快 (A组 :P <0 0 5 ,B组 :P <0 0 1) ,两组相比 ,对照组心率明显快于利多卡因组 (P <0 0 1)。术中甲状腺切除后T3 值与诱导前相比 ,两组均增高 (A组 :P <0 0 5 ,B组 :P <0 0 1) ,而两组间比较 ,对照组明显高于利多卡因组 (P <0 0 1)。两组术中心律失常发生率有明显差异 ,对照组高于利多卡因组 (P <0 0 5 )。结论 甲亢手术中泵入利多卡因可对术中心率的快速增加有一定的控制作用 ,同时可减少心律失常的发生率 ,可能对术中T3 的分泌有一定的抑制作用。

Objective To observe the effect of lidocaine on heart rate control and the excretion of thyroxine during thyroidectomy in patients with hyperthyroidism.Methods Fourty nine patients with hyperthyroidism undergoing elective thyroidectomy under general anaesthesia were randomly divided into 2 groups(lidocaine group and control group).In lidocaine group,lidocaine was infused at 10～20ml/h(80mg/10ml) when the operation began,and the rate was increased to 20～40ml/h if the heart rate was beyond 100bpm.No lidocaine group was control group.Results The highest heart rates increased significantly in both groups than those before induction(lidocaine group:P<0.05,control group:P<0.01).In control group,the heart rate was significantly higher than that in lidocaine group(P<0.01).The values of T 3 increased in both groups than before induction(lidocaine group:P<0.05,control group:P<0.01).In control group,the value of T 3 was significantly higher than that in lidocaine group(P<0.01).The incidence of arrhythmias in control group is significantly higher than that in lidocaine group(P<0.05).Conclusion Lidocaine can be used to control heart rate during thyroidectomy on patients with hyperthyroidism,it can also reduce the incidence of arrhythmias as well and may restrain the excretion of T 3.