利多卡因和黄芪对心室晚电位的干预作用

对３８例体表信号平均心电图（ＳＡＥＣＧ）检测为心室晚电位阳性的患者，分别子利子卡因静脉注射（１６例）或黄芪总甙注射液静脉滴注（２２例），每日１次，连续用２周。结果显示：利多卡因组２例（１２．５％）患者ＳＡＥＣＧ转为正常，但治疗前后平均ＳＡＥＣＧ指标无显著改变；黄芪组３例（１３．６％）患者ＳＡＥＣＧ转为正常，平均综合导联ＱＲＳ时限、ＬＡＳ显著缩短（Ｐ＜０．００１），ＲＭＳＪ４０增大（Ｐ＜０．０５），     

Saturation prostate biopsy with periprostatic block can be performed in office

PURPOSE: Recent reports of saturation prostate biopsy performed in the operating room with the patient under anesthesia have shown increased cancer detection rates over repeat office based prostate biopsy. We report equivalent success and tolerability of saturation biopsy in the office using local anesthesia. MATERIALS AND METHODS: We performed 24 core saturation prostate biopsies in 15 patients using periprostatic local anesthesia. Before biopsy 20 cc 2% lidocaine (10 cc per side) were injected under ultrasound guidance into the periprostatic nerve entry into the prostate bilaterally. After measurements were made a random 24 core prostate biopsy was performed using a spring loaded biopsy gun. Pain was determined using a visual analog scale to assess tolerability. RESULTS: Complete 24 core biopsies were successful and well tolerated in all 15 patients. Cancer detected in 5 patients (33%) was clinical stage T1C. Mean prostate specific antigen before biopsy was 11.2 ng./dl. (range 5 to 24.1). The indication for biopsy was elevated prostate specific antigen after a previous normal biopsy in 12 patients. In 2 patients prostatic intraepithelial neoplasia was noted on a previous biopsy and in 1 previous atypia was identified on biopsy. The mean visual analog scale pain score was 0.7 (range 0 to 3). Prolonged minor hematuria greater than 5 days in duration occurred in 3 cases requiring no intervention. No other complications occurred. Nerve sparing was not more difficult in the single patient who underwent radical prostatectomy. CONCLUSIONS: Saturation prostate biopsy is well tolerated in the office setting with the patient under local anesthesia. The additional risk, time and cost of performing these procedures in the operating room using anesthesia may be safely avoided.     

Laser assisted delivery of topical anesthesia for intramuscular needle insertion in adults

BACKGROUND AND OBJECTIVES: Currently there is no safe, effective, and rapid means to eliminate the pain associated with a needle insertion through the skin. It is hypothesized that ablation of the stratum corneum layer using a low energy Erbium(Er):YAG laser would allow rapid local anesthesia from a lidocaine product. STUDY DESIGN/MATERIALS AND METHODS: Eighty volunteers participated in a placebo-controlled, double blind, cross-over study employing the Norwood-Abbey (Chelsea Heights, Victoria, Australia) laser anesthesia device (LAD) and two lidocaine preparations. Upper-arm skin ablation was followed by a 5-minute application of study treatment. Pain scores were registered immediately following a needle insertion. RESULTS: Comparing the combined lidocaine preparations to placebo, there was a statistically significant reduction in pain when the LAD was employed (P < 0.001). The median pain reduction for lidocaine was 51.3% (95% CI = [40.9, 76.1]). CONCLUSIONS: Use of the low energy Er:YAG LAD device in combination with a 5-minute application of lidocaine significantly reduced the pain associated with a needle insertion.     

雌激素抗肾上腺素实验性心律失常作用

目的： 探讨雌激素在整体水平下的抗肾上腺素心律失常作用及可能机制.方法：24只新西兰大白兔随机分为对照组、利多卡因组及雌激素组,各组同步记录体表心电图及经左心室插管测定心功能指标[ 左心室内压（LVSP）、左心室舒张终末压（LVEDP）、左心室内压最大上升速率（＋dp/dtmax）、左心室内压最大下降速率（-dp/dtmax） ], 比较各组按75 μg/kg 静脉注射0.1%肾上腺素前后心电图及相应心功能指标变化.结果：快速静脉注射肾上腺素可引起心功能指标明显上升,同时由于自律性增高致室性心律失常;雌激素可拮抗肾上腺素所致心功能改变,并延长室早（VP）出现时间,缩短室速（VT）持续时间及心律失常持续时间,其作用优于利多卡因（P〈0.05）.结论： 雌激素对心律失常有一定对抗作用,可能与Ca^2＋阻断及改变细胞膜离子通透性有关.     

针刺对急性心肌梗死合并室性心律失常60例临床对照研究

[目的]探讨针刺对急性心肌梗死合并室性心律失常的疗效及其机制。[方法]采用临床对照设计方案,治疗组与对照组人数之比为1∶1,观察60例急性心肌梗死合并室性心律失常患者,治疗组采用针刺治疗,特定针刺手法和选穴,对照组采用利多卡因,按常规剂量静脉推注和静脉点滴。[结果]治疗组和对照组疗效无显著差别(P>0.05)。[结论]针刺治疗急性心肌梗死合并室性心律失常与利多卡因疗效相近,认为急性心肌梗死合并心律失常患者基本病因为:“心脉不畅,心神失养”;本质是“心血瘀阻,心神失调”;病属虚实夹杂证。同时确立了治疗大法为“理气通脉,养心安神”。     

生理药动学模型研究利多卡因静脉给药的体内过程

 目的建立血流限速型生理药动学模型,描述与预测在不同病理状态下人体静脉输注利多卡因后药物的体内过程。方法依据药物在体内血流限速的转运特征,在MATLAB/Simulink仿真环境下构建生理药动学模型的模拟平台;引入人体生理参数和利多卡因人体动力学参数,模拟已有报道的利多卡因人体试验给药方案,验证模型有效性,分析主要生理参数对药物体内过程的影响;模拟利多卡因的常规给药方案和不同的病理生理条件,预测各器官组织中药物的经时变化。结果建立了一个包含11个血流限速转运特征的器官(组织)房室的生理模型描述静脉输注利多卡因后药物的体内过程;模型密闭性好,预测值均在试验数据的1倍SD以内,心输出量变化对各器官利多卡因浓度的影响较分配系数、肝清除率的影响显著。结论生理药动学模型预测值与试验结果相符,对利多卡因的临床个体化给药有现实意义。     

芬太尼混合赛地合剂硬膜外阻滞对下腹部手术麻醉效果分析

目的:探讨下腹部手术患者芬太尼混合赛地合剂(2%盐酸利多卡因20ml 1%地卡因4ml)硬膜外麻醉的效果。方法:行下腹部手术患者80例,随机分成2组:赛地合剂组和芬太尼混合赛地合剂组,每组40例。赛地合剂组硬膜外注入赛地合剂13ml及生理盐水2ml;芬太尼混合赛地合剂组赛地合剂13ml混合芬太尼100μg硬膜外注入,记录感觉阻滞的起效时间、持续时间、最高平面及达最高平面的时间以及下肢运动阻滞评分,评价腹部运动阻滞、麻醉效果和不良反应。结果:与赛地合剂组比较,芬太尼混合赛地合剂组感觉阻滞的起效时间及达最高平面的时间缩短,持续时间延长,最高平面升高,腹肌运动阻滞和麻醉效果改善(P<0.05);2组下肢运动阻滞(Bromage评分)比较差异无统计学意义(P>0.05)。结论:下腹部手术患者混合芬太尼可增强赛地合剂硬膜外麻醉效果。     

Use of Topical Lidocaine Gel Plus Paracervical Blockade vs. Paracervical Blockade Alone for Pain Management During Manual Vacuum Aspiration: ADouble-Blind,Randomized, Placebo-Controlled Trial

Objective

To evaluate if the use of lidocaine gel applied to the cervix prior to manual vacuum aspiration (MVA) in addition to paracervical blockade is useful in reducing the level of pain associated with the procedure.

Myocardial protection by lidocaine hydrochloride in aorto-coronary bypass surgery

Myocardial protective effect of lidocaine hydrochloride on the ischemic myocardium was evaluated by serum (MB-CK) and cardiac function in 48 patients; 24 patients in control (C) and 24 patients in lidocainetreated group (L), who underwent aorto-coronary bypass surgery. Lidocaine hydrochloride, 1 mg/min was administered by continuous drip infusion from initiation of anesthesia, and throughout the operation and postoperative period for 24 hours. There were no significant differences between two groups with regard to duration of cardioplegia and cardiopulmonary bypass, hypothermic level and the number of grafts implanted. Serum MB-CK at 18–24 hours following cardioplegia was 39.5±15.2 I.U. (C) and 14.2±4.0 I.U. (L), (p<0.05). Cardiac index and stroke volume index were significantly increased in the lidocaine-treated group at 24 hours following aortocoronary bypass surgery, as compared to the control group. Lidocaine thus appears to be beneficial in aorto-coronary bypass surgery to prevent ischemic changes in the myocardium. The gist of this paper was read at the 82nd Meeting of the Japanese Surgical Society, April, 1981.     

Lidocaine and prevention of ventricular fibrillation complicating acute myocardial infarction

Prehospital prevention of primary ventricular fibrillation using 400 mg lidocaine i.m. may be effective in subjects aged under 70, but routine administration is not yet recommended since mortality was unaffected. Although in-hospital prevention of ventricular fibrillation can be achieved by routine i.v. administration of lidocaine in rather high dosages, this regimen is still controversial in well-equipped CCUs in view of conflicting results on mortality.