胸部硬膜外给予利多卡因对双腔气管插管患者血流动力学和唤醒水平的影响

doi:10.19723/j.issn.1671-167X.2019.04.026

摘要/Abstract

摘要：

目的:对比观察胸部硬膜外给予利多卡因对双腔气管插管患者血流动力学和唤醒水平的影响。方法:选择40例美国麻醉医师协会(American Society of Anesthesiologists,ASA)Ⅰ~Ⅱ级、年龄19~66岁拟在经口双腔气管插管全身麻醉下施择期手术的胸外科患者,分别为常规全身麻醉诱导下直接喉镜双腔气管插管组(T组,20例)和常规全身麻醉诱导复合胸部硬膜外给予利多卡因后实施双腔气管插管组(E组,20例)。麻醉诱导后分别采用Macintosh直接喉镜实施经口气管插管操作,观察两组患者麻醉诱导前后及气管插管时和气管插管后5 min内的血压(blood pressure,BP)、心率(heart rate,HR)、二重指数(rate pressure product,RPP)和脑电双频指数(bispectral index,BIS)的变化,并记录气管插管时间。结果:麻醉诱导后,两组患者的BP和RPP均较麻醉诱导前明显降低。与麻醉诱导后相比较,气管插管后两组患者的BP、HR和RPP明显升高。与麻醉诱导前相比较,气管插管后E组患者BP明显降低,T组患者收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)和平均动脉压(mean arterial pressure,MAP)明显升高,且持续时间约1 min。两组患者气管插管后HR均明显升高,T组患者HR增快持续约4 min,E组患者HR增快持续约1 min。与E组相比较,观察期内气管插管后T组SBP、DBP、MAP、HR和RPP均明显升高。与基础值相比,两组患者麻醉诱导后和气管插管后的BIS值均明显降低,且两组之间差异无统计学意义。与E组比较,观察期T组SBP大于基础值30%和RPP大于22 000的发生率明显较高,且E组中未见SBP大于基础值30%和RPP大于22 000的患者。结论:在双腔气管插管期间,硬膜外给予利多卡因可明显减轻插管导致的剧烈血流动力学变化,但对唤醒反应无影响。

关键词: 插管法, 气管内, 利多卡因, 血流动力学, 麻醉, 全身, 麻醉恢复期

Abstract:

Objective: To compare the effects of thoracic epidural administration of lidocaine on hemodynamic and arousal responses of double lumen tracheal intubation during induction of anesthesia. Me-thods: In the study, 40 patients with American Society of Anesthesiologists (ASA) physical statuses Ⅰ-Ⅱ,aged 19-66 years,scheduled for elective thoracic surgeries under general anesthesia requiring orotracheal intubation were allocated to either the double-lumen endobronchial intubation (T group) or double-lumen endobronchial intubation after epidural administration of lidocaine (E group). After an intravenous anesthetic induction, the orotracheal double-lumen intubation was performed using a Macintosh direct laryngoscopy (MDLS),respectively. Invasive blood pressure (BP),heart rate (HR) and bispectral index (BIS) were recorded before and after anesthetic induction,immediately after intubation and 5 minutes after intubation with 1-minute interval and the intubation time also noted. The rate pressure pro-duct (RPP) was calculated.Results: After anesthetic induction,BP and RPP in the two groups decreased significantly compared with their preinduction values. In comparison with their postinduction values, the orotracheal intubation in the two groups caused significant increases in BPs, HRs and RPP. In comparison with their preinduction values, BPs decreased significantly in E group, systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) increased significantly and lasted for 1 min in T group. The HRs of both groups after intubation were significantly higher than their baseline values,and increased in HR and lasted for 1 min and 4 min in E group and T group, respectively. SBP, DBP, MAP, HR and RPP after intubation in T group were significantly higher than those of E group during the observation period. The values of BIS were similar between both the groups. In T group, the incidences of SBP percent increased>30% of the baseline value and RPP more than 22 000 were significantly higher than in E group. None of the patients in group E had SBP more than 130% of the baseline value and RPP more than 22 000.Conclusion: During double-lumen endobronchial intubation, epidural administration of lidocaine can provide less hemodynamic response and similar arousal response.

Key words: Intubation, intratracheal, Lidocaine, Hemodynamics, Anesthesia, general, Anesthesia recovery period

中图分类号:

R614.42

刘鲲鹏,王宝宁,申琰琰,李卫霞,李昭,姚兰. 胸部硬膜外给予利多卡因对双腔气管插管患者血流动力学和唤醒水平的影响[J]. 北京大学学报（医学版）, 2019, 51(4): 742-747.

Kun-peng LIU,Bao-ning WANG,Yan-yan SHEN,Wei-xia LI,Zhao LI,Lan YAO. Effects of thoracic epidural administration of lidocaine on hemodynamic and arousal responses of double lumen tracheal intubation during induction of anesthesia[J]. Journal of Peking University(Health Sciences), 2019, 51(4): 742-747.

图/表 3

表1

两组患者的一般资料"

Items	Group T (n=20)	Group E (n=20)
Gender, Female/Male	5/15	4/16
Age/years, $x ?$ ±s	51.5±15.0	53.8±9.5
Height/cm, $x ?$ ±s	166.6±7.9	168.0±8.1
Weight/kg, $x ?$ ±s	64.1±10.9	69.4±9.5
Type of tube, Left/Right	9/11	12/8
Intubation time/s, $x ?$ ±s	46.0±16.6	49.0±11.9

表1

表2

两组患者的血流动力学变化比较(x?±s, n=20)"

Variables	Baseline	Post-induction	After intubation						Maximal values
Variables	Baseline	Post-induction	0 min	1 min	2 min	3 min	4 min	5 min	Maximal values
SBP/mmHg
Group T	146.3±13.3	98.4±19.5^*	160.6±41.4^#	165.4±39.7^*#	139.8±36.6^#	128.4±31.4^*#	122.9±25.3^*#	118.0±26.0^*#	187.6±40.4^*#
Group E	139.3.±13.8	86.7±13. $6 * ☆$	112.9±20. $0 *# ☆$	112.2±15. $7 *# ☆$	101.8±12. $7 *# ☆$	93.6±12. $3 * ☆$	89.8±12. $5 * ☆$	86.4±13. $1 * ☆$	131.4±19. $4 # ☆$
DBP/mmHg
Group T	75.4±8.5	56.5±10.6^*	94.8±25.3^*#	93.2±21.6^*#	83.0±21.1^#	77.7±20.1^#	74.0±19.6^#	72.5±18.7^#	112.3±17.9^*#
Group E	71.9±8.6	48.0±7. $0 * ☆$	67.3±14. $2 # ☆$	63.7±8. $4 *# ☆$	58.4±8. $5 *# ☆$	54.2±8. $2 *# ☆$	52.0±8. $3 * ☆$	49.5±8. $8 * ☆$	76.3±12. $6 # ☆$
MAP/mmHg
Group T	99.0±8.7	70.4±11.9^*	116.7±30.1^*#	117.3±23.8^*#	101.9±22.6^#	94.6±19.4^#	90.3±16.9^*#	87.6±16.2^*#	137.4±22.9^*#
Group E	94.3±9.0	60.9±8. $8 * ☆$	82.5±15. $9 *# ☆$	79.8±10. $3 *# ☆$	72.9±9. $6 *# ☆$	67.3±9. $3 *# ☆$	64.6±9. $4 * ☆$	61.8±10. $0 * ☆$	94.7±14. $1 # ☆$
HR/(beats/min)
Group T	83.0±13.1	77.8±15.4	103.9±16.3^*#	100.8±15.1^*#	96.3±15.9^*#	94.8±16.6^*#	92.7±16.7^*#	90.2±16.3^#	114.8±16.5^*#
Group E	78.7±9.8	72.0±10.8	82.0±14. $3 *# ☆$	82.9±13. $3 *# ☆$	80.6±12. $4 # ☆$	79.0±12. $4 # ☆$	77.6±12. $5 # ☆$	76.2±13.1^☆	92.8±11.9^*#☆
BIS
Group T	96.5±1.5	23.5±6.1^*	27.6±6.3^*#	30.1±8.6^*#	32.2±10.1^*#	36.8±10.5^*#	40.4±12.1^*#	45.0±13.4^*#	46.3±12.4^*#
Group E	97.1±0.9	23.4±6.4^*	26.3±2.8^*	27.5±5.9^*#	31.6±9.6^*#	35.1±11.9^*#	37.1±12.9^*#	39.0±11.9^*#	42.4±9.8^*#
RPP
Group T	121 00.0± 1 884.9	7 601.4± 1 909.2^*	16 804.0± 5 469.7^*#	16 603.2± 4 452.3^*#	13 434.7± 4 190.6^#	12 123.5± 3 590.4^#	11 317.5± 2 921.3^#	10 595.8± 2 762.0^#	21 544.7± 5 522.9^*#
GroupE	11 260.7± 1 610.1	6 929.1± 1 557.8^*	9 428.5± 3 085. $5 # ☆$	9 319.4± 2 149. $7 # ☆$	8 259.5± 1 996. $2 *# ☆$	7 449.2± 1 896. $1 *# ☆$	7 013.5± 1 812. $5 * ☆$	6 631.4± 1 825.8^*☆	12 245.1± 2 611.9^*#☆

表2

表3

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Items	Group T	Group E
SBP percent increase > 30% of baseline value	8 (40.0%)	0^*
SBP percent decrease > 30% of baseline value	13 (65.0%)	15 (75.0%)
HR percent increase > 30% of baseline value	12 (60.0%)	6 (30.0%)
HR percent decrease > 30% of baseline value	0	1 (5.0%)
RPP> 22 000	11 (55.0%)	0^*