小剂量利多卡因对丙泊酚麻醉诱导和维持效应的影响

目的:探讨小剂量利多卡因对丙泊酚麻醉诱导和维持效应的影响。方法:年龄18～65岁、按美国麻醉医师协会标准病情为Ⅰ～Ⅱ级、择期行全麻开胸手术的患者共40例纳入研究,用抽签法随机分为2组:利多卡因组和对照组,每组20例。麻醉诱导期和维持期2组患者给药顺序如下:(1)静脉滴注马来酸咪达唑仑0.03 mg/kg;(2)利多卡因组静脉滴注利多卡因1 mg/kg,之后持续滴注33μg.kg-1.min-1,对照组等速给予等量0.9%氯化钠注射液;(3)静脉滴注瑞芬太尼1μg/kg,之后持续滴注0.2μg.kg-1.min-1;(4)静脉滴注丙泊酚,起始血浆靶浓度为1 mg/L,每次以0.3 mg/L上调,使脑电双频指数(BIS)稳定在40～60;(5)意识消失后静脉注射罗库溴铵0.6 mg/kg。监测和比较2组患者围术期不同时间点的BIS、心率、有创动脉血压(IAP)、丙泊酚血浆靶浓度和效应室浓度、鼻咽温、阿托品或麻黄碱和硝酸甘油用量,以及不良反应和术后合并症发生率的差异。监测利多卡因组患者利多卡因血药浓度。结果:利多卡因组男13例,女7例,平均年龄(54±9)岁;对照组男13例,女7例,平均年龄(51±1)岁。2组患者的基本特征、麻黄碱或阿托品和硝酸甘油用量、BIS、IAP、鼻咽温及不良反应发生率差异均无统计学意义。2组均未发生严重不良反应与合并症。利多卡因组和对照组各时间点丙泊酚血浆靶浓度和效应室浓度分别比较如下:气管插管时,(1.9±0.4)mg/L比(2.4±0.4)mg/L,(1.2±0.4)mg/L比(1.6±0.4)mg/L;器官切除时,(2.0±0.5)mg/L比(2.7±0.7)mg/L,(2.0±0.5)mg/L比(2.7±0.7)mg/L;关胸时,(1.7±0.4)mg/L比(2.2±0.7)mg/L,(1.8±0.4)mg/L比(2.3±0.7)mg/L;拔管时(0.8±0.2)mg/L比(0.9±0.2)mg/L,(0.9±0.2)mg/L比(1.0±0.3)mg/L。差异均有统计学意义(均P<0.05)。利多卡因组患者在麻醉诱导后30、120、240 min和手术结束时血清利多卡因浓度分别为(2.24±0.53)、(2.20±0.42)、(2.45±0.73)和(2.31±0.75)mg/L,均低于中毒浓度(8 mg/L)。结论:小剂量利多卡因可增加丙泊酚诱导和维持的效应。

Effect of low-dose lidocaine on the efficiency of induction and maintenance of propofol anesthesia

Objective：To study the effect of low-dose lidocaine on the efficiency of induction and maintenance of propofol anesthesia.Methods：Forty ASA physical status ⅠorⅡpatients aged 18-65 years,who were scheduled to undergo elective thoracotomy under general anesthesia with propofol,were enrolled in the study and randomly divided into the following two groups by using ballot method： the lidocaine group and the control group（20 patients in each group）.The administration sequence during the anesthetic induction and maintenance in the two groups were as follows：（1） the patients received an IV infusion of midazolam maleate 0.03 mg/kg;（2） the patients in the lidocaine group were initially administered an IV infusion of lidocaine 1 mg/kg,followed by a continuous IV infusion of lidocaine 33 μg·kg-1·min-1,and the patients in the control group were administered the same volume of 0.9% sodium chloride at the same rate;（3） the patients received an IV infusion of remifentanil 1 μg/kg,followed by a continuous IV infusion of remifentanil 0.2 μg·kg-1·min-1;（4） an IV infusion of propofol was given,the initial target propofol blood concentration for induction was 1 ml/L,and then increased in steps of 0.3 mg/L at a time,achieving a stable bispectral index（BIS） of 40-60;（5） rocuronium was given intravenously 0.6 mg/kg after the patients lost consciousness.The differences in BIS,heart rate,invasive arterial pressure（IAP）,target propofol blood concentration,effect compartment propofol concentration,pharyngonasal temperature,doses of atropine or ephedrine or nitroglycerin,adverse reactions and complications in the two groups at the different time points during intraoperative period were monitored and compared.The patients＇lidocaine blood concentrations were monitored.Results： The lidocaine group comprised 13 males and 7 females with average age of（54±9）years.The control group comprised 13 males and 7 females with average age of（51±1）years.There were no statistically significant differences in baseline patient characteristics,doses of atropine or ephedrine or nitroglycerin,BIS,IAP,pharyngonasal temperature,and the incidence of adverse reaction between the two groups.There were no serious adverse reactions and complications in the two groups.The target propofol blood concentration and effect compartment propofol blood concentration in the lidocaine and control groups at the different time points were respectively compared as follows： at the time of tracheal intubation,the concentrations were（1.9±0.4） mg/L vs（2.4±0.4） mg/L and（1.2±0.4） mg/L vs（1.6±0.4） mg/L,respectively;at the time of organ resection,the concentrations were（2.0±0.5） mg/L vs（2.7±0.7） mg/L and（2.0±0.5） mg/L vs（2.7±0.7） mg/L,respectively;at the time of chest cavity shut,the concentrations were（1.7±0.4） mg/L vs（2.2±0.7） mg/L and（1.8±0.4） mg/L vs（2.3±0.7） mg/L,respectively;at the time of tracheal extubation,the concentrations were（0.8±0.2） mg/L vs（0.9±0.2） mg/L and（0.9±0.2） mg/L vs（1.0±0.3） mg/L,respectively.The differences were statistically significant（all P〈0.05）.The patients＇ lidocaine blood concentration 30,120,240 minutes after anesthetic induction and after surgery completion were（2.24±0.53）,（2.20±0.42）,（2.45±0.73） and（2.31±0.75） mg/L,respectively,and they were lower than a toxic blood concentration of lidocaine（8.0 mg/L）.Conclusion： The low-dose lidocaine can increase the efficiency of induction and maintenance of propofol anesthesia.