利多卡因对脑肿瘤患者麻醉诱导时脑氧供需平衡和血液动力学的影响

目的 研究全麻诱导中利多卡因对幕上肿瘤患者气管插管时脑氧供需平衡、能量代谢和血液动力学的影响。方法 将24例幕上肿瘤患者随机分为利多卡因组(A组，n=12)和空白对照组(B组，n=12)。在麻醉诱导前和气管插管即刻采取颈内静脉球部静脉血和桡动脉血，进行血气分析、乳酸和血糖测定。结果 A、B两组气管插管时较插管前脑氧摄取率、静动脉乳酸含量差下降；颈内静脉球部氧饱和度、动脉氧饱和度、动脉氧分压、颈内静脉球部氧分压、颈内静脉球部氧含量升高。组间比较血气指标在插管时-诱导前的变化仅颈内静脉球部氧分压有统计学意义。诱导期间A组血液动力学变化小于B组。结论 (1)利多卡因对幕上肿瘤患者麻醉诱导时脑氧供需平衡的变化无明显影响；(2)利多卡因能有效抑制脑肿瘤患者诱导时气管插管时血液动力学反应。

Effects of lidocaine on cerebral oxygen supply-consumption balance and hemodynamics during anesthesia induction in patients with supratentorial tumor.

OBJECTIVE: To study the effects of lidocaine on the balance between cerebral oxygen supply-consumption and on the hemodynamics during anesthesia induction in patients with supratentorial tumor. METHODS: Twenty-four patients with supratentorial tumor were randomly divided into lidocaine group (n=12) and control group (n=12). Blood gas analysis and determinations of plasma lactic acid and glucose in the radial artery and internal jugular venous bulb were performed. Oxygen extraction ratio (OER) and blood oxygen content in the artery and internal jugular venous bulb were calculated during anesthesia induction. RESULTS: OER and difference declined in plasma lactic acid level between the internal jugular venous bulb and the artery, and blood oxygen saturation as well as blood oxygen pressure in the internal jugular venous bulb and the artery increased along with blood oxygen content in the internal jugular venous bulb in both groups during anesthesia induction. Comparison between the groups showed that only the changes in blood oxygen pressure in the internal jugular venous bulb were statistically significant. Changes in the hemodynamics in lidocaine group were less obvious than those in the control group during anesthesia induction. CONCLUSION: Lidocaine does not significantly influence cerebral oxygen balance and may effectively inhibit hemodynamic response during anesthesia induction in patients with supratentorial tumor.