不同剂量利多卡因预防妇科腹腔镜手术全麻诱导时瑞芬太尼咳嗽反射的临床效果观察

目的观察不同剂量盐酸利多卡因预防妇科腹腔镜手术全麻诱导时静脉注射瑞芬太尼咳嗽反射的临床效果。方法选择美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级拟行腹腔镜手术的妇科患者150例，研究分为5组，每组30例。全麻诱导时，在静脉注射瑞芬太尼前，Ⅰ～Ⅳ组患者均先静脉注射不同剂量盐酸利多卡因。分别为Ⅰ组0．25mg·kg^-1，Ⅱ组0．5mg·kg^-1，Ⅲ组1mg·kg^-1，Ⅳ组1．5mg·kg^-1，2min后再按1．5μg·kg^-1静脉注入瑞芬太尼，注射时间2s。Ⅴ组为对照组，静脉注射0．9％氯化钠液3ml。根据患者出现咳嗽频率和强度进行评分，并观察各组静脉注射盐酸利多卡因后的副反应。结果咳嗽反射发生率Ⅱ、Ⅲ组显著低于Ⅴ组（P〈0．01），Ⅳ组无咳嗽反射。Ⅰ组虽低于Ⅴ组，但无显著性差异（P〉0．05）。Ⅲ组咳嗽发生率与Ⅱ组近似，但盐酸利多卡因不良反应却显著高于Ⅱ组（P〈0．05）。Ⅳ组无咳嗽反射发生，但盐酸利多卡因不良反应显著高于其他各组（P〈0．05或P〈0．01）。结论按0．5mg·kg^-1剂量预先静脉注射盐酸利多卡因可有效降低妇科腹腔镜手术全麻诱导期间瑞芬太尼所致咳嗽反射的发生率，且不出现盐酸利多卡因的不良反应。

Different doses of intravenous lidocaine suppress remifentanil-induced cough in gynecologic laparoscopy operation

Objective：To evaluate the effects of different doses of lidocaine on the incidence of remifentanilinduced cough in gynecologic laparoscopy operation. Methods：One hundred and fifty ASA Ⅰ and Ⅱ gynecologic patients for laparoscopy surgery were randomly allocated into five groups. The patients were administered lidocaine 0.25 mg · kg^-1 （Group Ⅰ）, 0.5 mg·kg^-1（Group Ⅱ）, 1.0 mg·kg^-1 （Group Ⅲ）, 1.5 mg·kg^-1 （Group Ⅳ） and saline 3 ml （Control group Ⅴ）,respectively. Two minutes later, Remifentanil （1.5 μg·kg^-1） was given through a peripheral cannula for two seconds. The occurrence of cough and vital sign profiles were recorded. Results：The incidences of remifentanil-induced cough in group Ⅱ and Ⅲ were significantly lower then control group（P〈0.01）. It was similar in group Ⅱ and group Ⅲ. There was no cough reflex in patients in group Ⅳ. There was no significant difference between group Ⅰ and Ⅴ （P〉0.05）. The incidences of adverse effects related to lidocaine were significantly higher in group Ⅲ and group Ⅳ than that in others （P〈0. 05）. Conclusions： Lidocaine （0. 5 mg/kg） injected intravenously 2 minutes prior to remifentanil injection reduces the incidence of remifentanil-induced cough and the adverse effects are less. It is an ideal premedicantion for general anesthesia with remifentanyl in gynecologic laparoscopy operation.