利多卡因局部浸润对宫颈锥切手术异丙酚效应室浓度及血流动力学参数影响

目的以脑电双频指数(BIS)为麻醉深度指标,探讨利多卡因局部浸润对宫颈锥切手术异丙酚效应室浓度及血流动力学参数的影响。方法择期行宫颈锥切手术病人50例,ASAⅠ～Ⅱ级,随机分为2组(n=25)。利多卡因局麻组(L组)宫颈周围以10g/L利多卡因加2.5mg/L肾上腺素20mL阻滞浸润,对照组(C组)宫颈周围以生理盐水加2.5mg/L肾上腺素20mL阻滞浸润,两组均在手术开始前6min静注芬太尼0.5μg/kg,手术开始前3min再次静注芬太尼0.5μg/kg,同时靶控输注异丙酚,起始靶浓度为3mg/L,术中依据BIS变化调整异丙酚的靶浓度(每次0.3mg/L),维持BIS50～60,手术结束前5min停止靶控输注。术中根据需要使用血管活性药物。于麻醉诱导前即刻(T0)、手术开始即刻(T1)、手术10min(T2)、手术20min(T3)、手术结束(T4)、呼之睁眼(T5)以及离室(T6)时记录心率(HR)、收缩压(SBP)、平均动脉压(MAP)、呼吸频率(RR)、脉搏氧饱和度(SpO2)、BIS和异丙酚效应室浓度,同时记录手术时间、药物用量、苏醒时间、离室时间及不良反应。结果 L组病人T2～T5时间点异丙酚效应室浓度显著低于C组(t=3.915～10.179,P<0.01),L组异丙酚总量也明显小于C组(t=6.591,P<0.01)。诱导后两组SBP、MAP在术前降至最低(F=9.805～13.910,P<0.01)。术中和术后各时间点,L组HR、SBP及MAP控制较为理想,在各时间点均低于C组(t=3.429～9.501,P<0.01)。L组病人的苏醒时间和离室时间明显短于C组(t=10.915、6.846,P<0.01)。不良反应的发生率L组显著低于C组(χ2=4.35～7.71,P<0.05、0.01)。结论宫颈锥切手术中利多卡因局部浸润可使异丙酚效应室浓度降低,用药量减小,血流动力学参数更平稳,不良反应减少,苏醒及离室时间缩短。

INFLUENCE OF LOCAL INFILTRATION OF LIDOCAINE ON TARGET EFFECTIVE-SITE CONCENTRATION OF PROPOFOL AND HEMODYNAMICS IN CONIZATION OF CERVIX

Objective To investigate the influence of local infiltration of lidocaine on target effective-site concentration(TESC)of propofol and hemodynamics in conization of cervix by TCI with BIS as the index of depth of anesthesia.MethodsFifty ASA Ⅰ-Ⅱ patients scheduled for conization of cervix were evenly randomized to two groups:lidocaine-local-infiltration group(group L),20 mL of 10 g/L lidocaine containing 2.5 mg/L adnephrin was locally infiltrated around cervix;control group(group C),20 mL of NS containing 2.5 mg/L adnephrin,administered same as group L.All the patients were given intravenous 0.5 μg/kg of fentanyl six minutes before operation,and then given another same dose of fentanyl three minutes later,and meanwhile started the TCI of propofol.Results The initial target concentration of propofol was set at 3.0 mg/L,the target concentration of propofol was adjusted(0.3 mg/L each time)based on the changes of BIS,which was kept at 50-60.The TCI was stopped five minutes before the end of the operation.Vasoactive drugs were given at surgery when needed.HR,SBP,MAP,RR,SpO2,BIS and target concentration of propofol TCI were recorded immediately before anesthetic induction(T0)and before the operation(T1),at 10 and 20 minutes after the beginning of operation(T2,T3),at the end of operation(T4),when the patients regained consciousness(T5),and when the patients left the operating room(T6).The total amount of propofol and fentanyl,adverse reactions and the duration of operation,regaining consciousness and leaving room were recorded as well.The TESC of propofol at different time points during operation and at analepsia was significantly lower in group L than that in group C(t=3.915-10.179,P<0.01).The total amount of propofol in group L was significantly less than that in group C(t=6.591,P<0.01).After induction,SBP and MAP of the two groups reached the lowest level before the operation(F=9.805-13.910,P<0.01).Duringand after operation,HR,SBP and MAP in group L were better controlled and lower than that of group C at various time points(t=3.429-9.501,P<0.01).The duration of analepsia and room stay was shorter in group L than in group C(t=10.915,6.846;P<0.01).The incidence of adverse reaction was significantly lower in group L than in group C(χ2=4.35-7.71,P<0.05,0.01).ConclusionLocal infiltration of lidocaine in conization of cervix can reduce the TESC of propofol,decrease the dose of propofol used,stabilize hemodynamics,diminish untoward reaction,and shorten the duration of analepsia and operating room stay.