静脉注射利多卡因对气管插管病人BIS值及应激反应的影响

中国临床药理学与治疗学 ›› 2011, Vol. 16 ›› Issue (12): 1402-1405.

静脉注射利多卡因对气管插管病人BIS值及应激反应的影响

王红珠, 陈冯琳, 王明仓

浙江省台州医院麻醉科,台州 317000,浙江

收稿日期:2011-08-25 修回日期:2011-11-24 出版日期:2011-12-26 发布日期:2012-01-07
作者简介:王红珠,女,本科,主治医师,研究方向:临床麻醉,围术期应激反应。Tel: 13515866568 E-mail: wanghz@enzemed.com

Effect of intravenous lidocaine on bispectral index and stress reaction in patients undergo tracheal intubation

WANG Hong-zhu, CHEN Feng-lin, WANG Ming-cang

Department of Anesthesiology, Taizhou Hospital of Zhejiang Province, Taizhou 317000, Zhejiang, China

Received:2011-08-25 Revised:2011-11-24 Online:2011-12-26 Published:2012-01-07

摘要/Abstract

摘要： 目的: 观察利多卡因对丙泊酚麻醉诱导气管插管时血浆儿茶酚胺与脑电双频指数(BIS)变化的影响,探讨利多卡因抑制气管插管反应的机制。方法: 60例患者随机分为对照组(C组)和利多卡因组(L组)。L组先静脉注射利多卡因1.5 mg/kg,C组注入等量生理盐水,然后两组均静脉注射丙泊酚2 mg/kg、芬太尼4 μg/kg、罗库溴铵0.6 mg/kg麻醉诱导后气管插管,机械通气。分别于麻醉诱导前(T₀)、气管插管前(T₁)、气管插管后即刻(T₂)、气管插管后1 min(T₃)、3 min(T₄)记录BIS值、心率(HR)、收缩压(SP)、舒张压(DP)。并于T₀、T₁、T₃时采集桡动脉血7 mL测定肾上腺素(Ad)、去甲肾上腺素(NA)的浓度。结果: C组SP、DP、HR在气管插管后显著升高(P<0.05),而T₃时血浆中Ad、NA浓度与T₀比较无统计学差异(P>0.05);L组在T_1-4时的BIS值显著低于C组(P<0.05),T₃时血浆中Ad、NA浓度与T₀及C组比较均有统计学差异(P<0.05)。结论: 利多卡因能降低丙泊酚麻醉的BIS值及血浆儿茶酚胺浓度,提示其静脉给药时的镇痛镇静作用。该特性使静注利多卡因(1.5 mg/kg)能抑制气管插管引起的BIS变化及减轻应激反应。

关键词: 利多卡因, 插管法,气管内, 儿茶酚胺类, 脑电描记术, 血流动力学

Abstract: AIM: To observe the relationship between the level of catecholamine with bispectral index during endotracheal intubation with propofol anesthesia in order to investigate the mechanism of the preventing of endotracheal intubation response with lidocaine.METHODS: Sixty patients were randomly allocated into two groups:control group (Group C) and lidocaine group (Group L). The patients received lidocaine 1.5 mg/kg in Group L and saline in Group C before induction of anesthesia. Anesthesia was induced with propofol (2 mg/kg) and fentanyl (4 μg/kg) and tracheal intubation was facilitated with rocuronium (0.6mg/kg) in all patients. Bispectral index (BIS), systolic pressure(SP), diastolic pressure(DP)and heart rate(HR)were continuously monitored and recorded before induced of anesthesia(T₀), preintubation(T₁),immediately and 1,3 min after intubation (T_2-4). Arterial blood samples were obtained at T₀, T₁ and T₃ for determination of plasma concentration of adrenaline (Ad) and noradrenaline(NA).RESULTS: SP, DP,HR were significantly increased after intubation in Group C compared with baseline values at T₀(P<0.05),while plasma Ad and NA concentrations at T₃ were of no statistic significance(P>0.05). Compared with Group C, BIS value at T₁ to T₄ decreased significantly in Group L(P<0.05). Plasma Ad and NA were lower at T₃ in Group L than those in Group C and T₀(P<0.05).CONCLUSION: Lidocaine can further reduce BIS value and the plasma concentration of catecholamines during propofol anesthesia, indicating the sedative and anti-nocieptive effect of intravenous lidocaine. Lidocaine(1.5 mg/kg)can restrain the changes of BIS and reduce stress reaction caused by tracheal intubation.

Key words: Lidocaine, Intubation, Intratracheal, Catecholamines, Electroencephalography, Hemodynamics

中图分类号:

R614

王红珠, 陈冯琳, 王明仓. 静脉注射利多卡因对气管插管病人BIS值及应激反应的影响[J]. 中国临床药理学与治疗学, 2011, 16(12): 1402-1405.

WANG Hong-zhu, CHEN Feng-lin, WANG Ming-cang. Effect of intravenous lidocaine on bispectral index and stress reaction in patients undergo tracheal intubation[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2011, 16(12): 1402-1405.

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