鼻内镜手术麻醉时肾上腺素对血压的影响

目的：观察全身麻醉鼻内镜手术中局部浸润麻醉时肾上腺素对血压的影响,为临床工作提供参考.方法：采用随机双盲对照方法,将90例择期全身麻醉下鼻内镜手术患者随机分为三组,每组30例.A组：注射含1：200000肾上腺素的2%利多卡因2ml,肾上腺素总量10μg;B组：注射含1：200000肾上腺素的等渗盐水2ml,肾上腺素总量10μg;C组（对照组）：注射等渗盐水2ml.术中监测采用持续心电图及桡动脉测压,并记录浸润注射前（基础值）和注射后0.5、1、1.5、2、3、4、5 min 8个时间点的收缩压（SBP）、舒张压（DBP）、平均动脉压（MAP）和心率（HR）.结果：与浸润注射前的基础值相比,A、B组出现明显的血流动力学变化,尤其是在1.5min时出现明显的血压下降（P＜0.001）,并伴有心率增快（P＜0.001）;C组血压和心率则无明显变化（P＞0.05）.组间比较时,A、B组与C组比较,出现血压下降和心率增快;而A组与B组相比,在各个时间点上均无明显变化.结论：全身麻醉下鼻内镜手术中局部浸润麻醉时肾上腺素可引起短时间的血压下降和其他血流动力学改变,但持续时间不超过5min.

Marked hypotension induced by adrenaline contained in local anesthetic

Objective:To observe the hemoclynamic changes caused by adrenaline contained in local anesthetic. Methods:Ninety adult patients undergoing functional endoscopic sinus surgery (FESS) under general anesthesia were randomly allocated into three groups. Group A(n=30) received 2% lidocine 2 ml with adrenaline (1:200000) , group B(n = 30) received saline 2 ml with adrenaline (1:200000) , and group C(n = 30 , control group) received saline 2 ml without adrenaline for local infiltration. Electrocardiogram (ECG) and heart rate (HR) were monitored; systolic blood pressure (SBP) , diastolic blood pressure (DBP) , and mean arterial blood pressure (MAP) were directly measured in radial artery continuously after local infiltration. SBP, DBP, MAP and HR were recorded at 8 time points:before infiltration (baseline) ,0.5, 1,1. 5, 2, 3, 4 and 5 minutes after infiltration. Results:Significant hemody-namic changes, particularly hypotension (P<0 .001) , after local infiltration were observed in group A and group B compared with the baseline, but not in group C. However, there were no significant hemo-dynamic changes between group A and group B at the same time points (P > 0 .05). The significant he-modynamic changes lasted no longer than 5 minutes. Conclusion:Lidocaine (2%) or saline with adrenaline (1:200 000) does cause temporary hypotension and other hemodynamic changes during general anesthesia, which last no longer than 5 minutes. The causative mechanism is the effect of adrenaline.