利多卡因对颅内动脉瘤夹闭术后患者呛咳、血压和心率的影响

目的 观察静脉注射利多卡因对颅内动脉瘤夹闭术患者麻醉恢复期的呛咳、躁动、血压和心率的影响。方法 前瞻性选择我院2013年8月至2014年5月开颅夹闭术治疗的颅内动脉瘤患者60例，随机分为对照组和试验组，每组30例。两组患者均给予相同药物进行麻醉诱导和麻醉维持。术毕对照组静脉注射生理盐水（0.15 ml/kg），试验组静脉注射1%利多卡因（0.15 ml/kg）。结果 术后气管导管留置期间和拔管期间，试验组患者咳嗽评分明显低于对照组（P<0.05），试验组拔管时间、丙泊酚和佩尔地平用量均明显少于对照组（>P<0.05）。气管导管拔管后5 min内，两组收缩压、舒张压和心率均随时间变化显著下降（P<0.05），但均高于手术结束时（>P<0.05），且对照组明显高于试验组（>P<0.05）。>结论 静脉注射利多卡因可降低颅内动脉瘤夹闭术患者麻醉恢复期的呛咳和躁动，减少拔管期间的血压和心率波动。

Effects of lidocaine on coughing,blood pressure and heart rate after surgery in patients with intracranial aneurysms

Objective To observe effects of intravenous lidocaine on coughing, restlessness, blood pressure and heart rate in patients undergoing intracranial aneurysm clipping during anesthesia recovery. Methods 60 patients (ASA grade Ⅱ~Ⅲ) underwent intracranial aneurysm clipping were randomly divided into 2 groups: group C (control group) and group L (experimental group), n=30. Patients were administered 0.15ml/kg physiological saline in group C and 0.15 ml/kg 1% lidocaine in group L after surgery. When patients did not reach requirement of tracheal extubation, they were administered 30~50 mg/time intravenous propofol if patients had agitated or coughed. Patients were administered 0.25 mg/time nicardipine if SBP>150 mmHg by intravenous injection. Total dose of propofol and nicardipine and ephedrine were computed. Results The time of extubation, grade of coughing, the total dose of propofol and perdipine after surgery, blood pressure and heart rate within 5 min after tracheal extubation, were significantly lower in group L than in group C (P