不同浓度利多卡因用于臂丛神经阻滞麻醉的临床观察

目的 寻找适用臂丛神经分离阻滞麻醉的最佳利多卡因浓度。方法 选择80例前臂与手部手术患者，随机分为8组(每组各10例)，1组用0．25％罗哌卡因24ml，其他各组分别予以2％利多卡因1、2、3、4、5、6、12ml与0．25％罗哌卡因混合，混合液均为24ml，1～8组均经锁骨上入路行臂丛神经阻滞麻醉。分别记录其麻醉起效时间，5、10、15、20min时患肢肌力及感觉阻滞维持时间。结果 0．17％利多卡因能明显加快0．25％罗哌卡因的起效时间，但并不加深对运动神经的阻滞。不同浓度利多卡因与0．25％罗哌卡因的混合液与单纯0．25％罗哌卡因相比其感觉阻滞维持时间无显著差异。随利多卡因浓度增加，其运动神经阻滞作用逐渐增强。结论 0．25％的罗哌卡因与0．17％利多卡因的混合液用于锁骨上臂丛神经分离阻滞麻醉是较优的组合。     

Sponge-Oberflächen-Anästhesie mit intracameraler Lidocain-Applikation Kataraktchirurgie

BACKGROUND: For cataract surgery in this country retro- and peribulbar anesthesia is the standard method. It totally stops eye movement as well as sensitivity to pain. Especially peribulbar anesthesia is known as a procedure with minimal complications, but the potential risks can be severe. In the past sponge anesthesia could not be used on patients with difficult cataract surgery due to the insufficient anesthetic effect. A modified anesthetic method is demonstrated for complicated cataract surgery. PATIENTS AND METHODS: In 281 non-selected, successive phacoemulsifications, all performed by the same surgeon, we applied sponge anesthesia and 1.5 mg midazolam as premedication. Only in cases of moderate and severe sensitivity was 1% 0.15 ml lidocaine applied intraocularly. The intensity of sensitivity was graded as 1 for low, 2 moderate, and 3 severe. RESULTS: Ninety eyes had complicated cataract surgery. Of the patients, 84.3% felt no pain during surgery; 11.4% were part of group 2 (moderate). Ten of 12 patients who had stated moderate sensitivity at first were free of pain after intraocular application of lidocaine, while the other 2 patients only felt minor sensitivity. CONCLUSION: The anesthetic procedure we present offers a safe alternative method to surgeons who are able to do surgical procedures on a mobile eye.     

Lipomatosis dolorosa – ein häufig übersehenes Krankheitsbild

Dercum's disease (lipomatosis dolorosa) is a relatively unknown illness. The disorder usually affects middle-aged females. Subcutaneous fatty tissue deposits may occur in many parts of the body. The upper arms, elbows, stomach wall, buttocks, thighs, or knees are most commonly affected. Severe hyperalgesia is found on light pressure and touch. Analgesics or pain-modulating drugs usually have little or no effect. The following case report demonstrates successful symptomatic treatment of the otherwise nearly unbearable complaints: intravenous infusions of 5 mg/kg body weight of lidocaine over 30-90 min may give pain relief lasting several weeks or even months. Alternatively, patients are treated with 150-750 mg orally administered mexiletine daily. Surgical excision or liposuction of these fatty tissue deposits have shown significant reduction of pain. However, this effect reduces over time and recurrences often develop.     

利多卡因降低神经外科危重病人应激反应的研究

目的 对利多卡因降低神经外科危重病人就激过度所致损伤的临床疗效进行研究。方法 ４０例神经外科危重病人,在基础治疗的同时２０例采用利多卡因治疗（治疗组）,２０例按以往常规治疗（对照组）。对两组激素水平（胃泌素、骨皮素、抗利尿激素）、血糖、胃液的ｐＨ进行测定,观察两组的临床疗效。结果 治疗组胃泌素、内此素、抗利尿激素、血糖明显下降;对照组胃泌素、内皮素、抗利尿激素、血糖均高于正常水平。结论 利多卡因的     

急性心肌梗死溶栓中一些特殊问题的研究

目的：研究急性心肌梗死溶栓过程中出现的一些特殊问题,以减少急性心肌梗死溶栓的并发症。方法：按照是否应用利多卡因,尿激酶和rt-PA对病人分组,观察一过性低血压,致命性心律失常,心力衰竭,出血及再梗死等的发生情况。结果：一过性低血压多发生于尿激酶组（P＜0．01）,利多卡因组心衰发生率高于非利多卡因组（P＜0．01）,利多卡因组与非利多卡因组比较,致命性心律失常发生率无显著差异（P＞0．05）,结论：一过性低血压发生可能与变态反应有关,利多卡因并不能有效预防致命性心律失常发生,在溶栓过程中要密切注意血压变化,切忌盲目使用利多卡因。     

腰大肌间沟注射碱化镇痛液治疗根性坐骨神经痛

目的　观察碱化镇痛液注入腰大肌间沟治疗根性坐骨神经痛的临床疗效。方法　将 1 0 8例随机分为LPVS、LPV两组 ,采用病人单盲法分别在腰大肌间沟注入碱化镇痛液 (利多卡因 2 0 0mg +强的松龙 2 5mg +维生素B1 2 1mg +碳酸氢钠 2 0 0mg加生理盐水至 2 0ml)和宋文阁氏镇痛液 (利多卡因 2 0 0mg +强的松龙 2 5mg +维生素B1 2 1mg加生理盐水至 2 0ml) ,用VRS - 5、直腿抬高试验等评估镇痛效果。结果　LPVS、LPV两组有效率分别为 88.89%、72 .2 2 %(P <0 .0 5 )。结论　碱化镇痛液注入腰大肌间沟治疗根性坐骨神经痛可显著提高临床疗效     

大剂量利多卡因静脉麻醉对心肌酶和心肌收缩力的影响

目的观察大剂量利多卡因全静脉麻醉对心胸外科手术患者心肌酶和心肌收缩力的影响。方法①心肌酶的观察 :将 60例成人ASAⅡ～Ⅲ级普通胸科 (普胸 )手术随机分成 3组 ,每组 2 0例。Ⅰ组为观察组 ,麻醉诱导和麻醉维持均选用利多卡因 ,伍用地西泮、芬太尼等 ;Ⅱ、Ⅲ组为对照组。 3组均检测麻醉开始前、手术结束时和术后 3 6小时的心肌酶谱 ,用t检验比较变化情况。②心肌收缩力的观察 :选择房间隔缺损修补术 15例、室间隔缺损修补术 43例 ,采用普胸Ⅰ组的麻醉方式及晶体冷停跳液灌注转流方式 ,观察心脏复跳后心肌收缩力强弱。结果①心肌酶谱 :术毕和术后 3 6小时Ⅰ组均高于Ⅱ组和Ⅲ组 (P <0 0 5 ) ;同组术毕和术后 3 6小时与术前比较存在显著性差异 (P <0 0 1和P <0 0 5 ) ;同组术后 3 6小时与术毕比较亦有显著性差异 (P <0 0 5 )。②心肌心缩力 :房间隔缺损修补术心脏复跳后发生轻度心肌收缩无力 6例、重度 3例 ;室间隔缺损修补术发生轻度心肌收缩无力 17例、重度 10例。结论静脉麻醉剂可预防或减轻大剂量利多卡因中毒所致的骨骼肌抽搐 ,但对心肌的毒副反应无防治作用     

Zur toxikologischen Bewertung der Lokalanästhetika Lidocain und Tetracain bei Drogentodesfällen

In recent years an increasing number of drug fatalities with blood concentrations of lidocaine up to 33 μg/ ml or of the tetracaine metabolite 4-n-butylaminobenzoic acid up to 8.6 μg/ml was observed in Berlin. These high concentrations originated from the use of the local anaesthetics as adulterants in cocaine, heroin or cocaine-heroin mixtures. The comparison of the lidocaine concentrations with that of 38 fatalities with a different cause of death, in which the drug was used as an antiarrhythmic during resuscitation attempts (0.1–24 μg/ml) and with literature data on local anaesthesia accidents leads to the conclusion that in a substantial number of drug cases an intoxication by the local anaesthetics alone or in combination with other drugs is sufficient to death. In seven cases the concentration of 4-n-butylaminobenzoic acid was above 4 μg/ml (corresponding to > 5.5 μg/ml tetracaine). These values confirm the stronger toxicity of tetracaine in comparison to lidocaine known from the literature. As a reason for the particularly high danger of the use of local anaesthetics as adulterants in illicit drug mixtures, it must be assumed that after application of normal amounts by intravenous bolus injection, very high blood concentrations appear immediately in the heart and CNS, which cause death by central paralysis and blockade of the cardiac conduction system.     

抽脂患者皮下注射利多卡因血清与唾液浓度的相关性及其药代动力学研究

本文利用高效液相色谱法对12名抽脂健康患者皮下注射利多卡因的血清、唾液及脂肪浓度进行了测定,探讨了血清与唾液中药物浓度的相关性,并比较了二者之间的药代动力学参数。患者的平均给药剂量为20mg/kg,单剂量给药。实验结果表明血清与唾液中药物浓度呈线性关系:r=0.8043(p<0.01),C_(血清)=0.3433C_(唾液)+0.2620(n=78).唾液与血清药物浓度比值为2.37±0.857(比值范围:1.02～4.09,n=78).测得血清及唾液药代动力学参数分别为:吸收速率常数(Ka)0.573±0.583h~(-1),0.478±0.270h~(-1);消除半衰期(t_(1/2)k)6.41±2.08h,5.68±1.76h;达峰时间(T_(max))6.63±1.46h,6.67±1.80h;峰浓度(C_(max))2.52±0.926μg/ml,6.31±2.30μg/ml.血清与唾液的动力学参数除峰浓度(C_(max))外,统计学上均无明显差异(P>0.05).患者被抽出脂肪的药物含量为给药总量的31.84%(20.69～47.90%).