吸脂术中大剂量使用利多卡因的血药浓度监测及意义

目的探讨作为局部麻醉剂的利多卡因在肿胀法脂肪抽吸术中的极限剂量是多少,既能达到良好的镇痛效果,又能安全地使用而不产生毒副作用。方法对14例大剂量使用低浓度利多卡因作为局麻药的脂肪抽吸术的术中和术后血清利多卡因浓度以免疫荧光测定法进行了动态监测,作出其时间-浓度曲线,并与临床表现相对照。结果在此类手术中,利多卡因在0.1mg/ml的浓度下,加入1/1百万～1/2百万肾上腺素,其用量可达35mg/kg 体重而血清高峰浓度仍在安全范围内,无中毒症状,既可减轻病人的疼痛,又可减少出血,提高安全性,增加脂肪抽吸量。结论本研究为肿胀法吸脂术中大剂量使用利多卡因的临床实践提供了理论依据。

Monitoring of serum lidocaine concentration in tumescent liposuction infiltrated with high-dosage lido- caine and its clinical significance

Objective This study was carried out to determine the maximum and safe dosage of li- docaine administered in tumescent liposuction.Methods In 14 cases of tumescent liposuction using high- dosage,low-concentration lidocaine as local infiltration anesthetic,serum lidocaine concentrations were monitored with automated fluorescence polarization analysis.Results The time-concentration curve to- gether with clinical manifestations indicated that in tumescent liposuction,lidocaine,under a concentration of 0.1 mg/ml mixed with 1/1000000 to 1/2000000 epinephrine,could be administered with a dosage of 35 mg/kg body weight as a local infiltration anesthetic while the serum lidocaine was still within the safety limit and no signs of intoxication manifested.The resulting diminution both in pain and blood loss during the operation enhanced the overall operation safety and suction volume.Conclusion This study provides the basis for high-dosage lidocaine administration in tumescent liposuction.