碳酸利多卡因在硬膜外麻醉中硬膜外持续输注给药方案设计

 目的 设计碳酸利多卡因硬膜外持续输注给药方案。方法 采用荧光偏振免疫分析方法测定血清利多卡因浓度。采用先给予常规剂量，根据对碳酸利多卡因在实施硬膜外麻醉患者中的药物动力学及药效学研究结果，计算出硬膜外持续输注给药速率，实施硬膜外持续给药。结果 对16例患者在硬膜外持续输注给药后30 min，手术中期及手术后期的48份血药浓度进行监测，同时对所有患者在手术全过程中的血压及心率进行连续监测。结果表明，平均常规给药剂量为(3.72±0.55) mg·kg^-1，平均硬膜外持续输注速率为(33.80±6.74) μg·kg^-1·min^-1，平均血药浓度为(2.76±0.98) μg·ml^-1(n=48)，手术过程中麻醉效果满意，患者的血压及心率正常。结论 采用先给予常规剂量，后持续硬膜外输注给药的方案，即可获得满意的麻醉效果，又克服了由于硬膜外重复给药所引起的血药浓度的较大波动及由此对药效学产生的不利影响。

Administrationschedule design on continued epidural infusion of lidocaine carbonate in patients duringepidural anesthesia

OBJECTIVE To design the dosage plan of continued epidural infusion of lidocaine carbonate.〖WTHZ〗METHODS The pharmacokinetics and pharmacodynamics of lidocaine carbonate in 15 patients during epidural anaesthesia were studied.Serum concentrations of lidocaine were measured by fluorescence polarization immunoassay method.The serum level of lidocaine,blood pressure and heart rate in 16 patients were monitored during surgical operation under epidural anaesthesia.These patients were given a routing dose at first,then administrated by epidural infusion rate of 20～40 μg·kg^-1·min^-1. RESULTS The range of serum concentrations for maintaining the effective anaesthesia was obtained,i.e.(2.61±0.59) μg·ml^-1,according to the results getting from the pharmacokinetics and pharmacodynamics of lidocaine carbonate in15 patients.The epidural infusion rate of lidocaine carbonate was calculated approximately by using the clearance of lidocaine and the results of pharmacokinetics-pharmacodynamics study,it ranged from 20 μg·kg^-1·min^-1to 40μg·kg^-1·min^-1.The mean routing dose was (3.72±0.55) μg·kg^-1,the mean rate of epidural infusion was (33.80±6.74) μg·kg^-1·min^-1,the mean serum level of lidocaine in 48 monitored samples (there were 3 samples for each patient:in 30 min after continued epidural infusion,in the middle and later period of surgical operation.)was (2.76±0.98) μg·ml^-1,the blood pressure and heart rate of all patients were normal.The anaesthesia effect was satisfied during the surgical operation.CONCLUSION The dosage plan of routing dose plus continued epidural infusion was beneficial to both getting satisfied anaesthesial effect and avoiding obvious fluctuation of serum lidocaine concentrations casued by repeated-drug administration and the abverse affect foranaesthesia effect caused by the fluctuation of serum concentration of lidocaine.