利多卡因不同给药方式对老年高血压患者全麻拔管应激反应的影响

发布时间：2018-03-13 22:00

本文选题：利多卡因　切入点：高血压　出处：《中国老年学杂志》2015年18期 　论文类型：期刊论文

【摘要】：目的探讨静脉和气管内注射利多卡因对老年高血压患者全麻拔管应激反应的影响。方法选择2013年9月至2014年1月择期行甲状腺手术的老年高血压患者60例,血压控制稳定,年龄60~85岁,美国麻醉医师学会(ASA)分级Ⅰ级或Ⅱ级,随机分成利多卡因气管内麻醉组(T组),静脉给药组(V组)和对照组(C组),每组20例。手术结束前20 min T组于气管内给予2%利多卡因3 ml、V组静脉注射2%利多卡因1.5 mg/kg,C组不经气管或静脉给予任何药物。观察全麻诱导前T0(基础值),手术结束时(T1),拔管时(T2),拔管5 min(T3)各时间点平均动脉压(MAP)、心率(HR)、血浆皮质醇浓度(Cor)、肾上腺素(E)和去甲肾上腺素(NE)的变化和拔管5 min内患者呛咳程度。结果与C组相比,T组和V组在拔管时和拔管后患者的呛咳程度明显低于对照组(P0.01),所有患者T2、T3的MAP、HR、血浆Cor、E和NE浓度均比T0和T1增高;与C组相比,T组和V组在T2、T3时间点MAP、HR、血浆Cor、E和NE浓度较低;与V组相比,T组MAP、HR和Cor和NE浓度在T2和T3时刻更低(P0.05)。结论静脉和气管内注射利多卡因均能明显预防老年高血压患者拔管应激反应的发生,气管内给药效果更佳。
[Abstract]:Objective to investigate the effect of intravenous and intratracheal injection of lidocaine on the stress response of extubation under general anesthesia in elderly patients with hypertension. Methods 60 elderly hypertensive patients undergoing thyroid surgery from September 2013 to January 2014 were selected and their blood pressure was controlled stably. Aged 60 to 85 years, the American Society of Anesthesiologists (ASA) grade I or II, They were randomly divided into two groups: lidocaine intratracheal anesthesia group (group T), intravenous administration group (group V) and control group (group C, n = 20). Twenty min before operation, group T received 2% lidocaine (3 ml / V) intravenously 2% lidocaine (n = 20). The mean arterial pressure (MAPP), heart rate (HRT), plasma cortisol concentration (Corr, epinephrine E) were observed at different time points in mg / kg / kg C group before induction of general anesthesia (basic value, T1 at the end of operation, T2 + T2 during extubation and T3 at 5 min after extubation), and plasma cortisol concentration (Corr, epinephrine E) was observed. Results compared with group C and group C, the degree of cough choking during extubation and after extubation in group T and group V was significantly lower than that in control group (P 0.01). The MAPHRs of T _ 2 T _ 3, plasma Corn E and NE concentration in all patients were significantly lower than those in control group (P < 0.05). The degree was higher than that of T 0 and T 1. Compared with group C, the concentrations of Corn E and NE in plasma of T group and V group were lower than those of group C at T _ 2T _ 3 time point. Compared with group V, the concentrations of MAPHR, Cor and NE in group T were lower than those in group V. conclusion intravenous injection of lidocaine and intratracheal injection of lidocaine can significantly prevent extubation stress in elderly patients with hypertension, and the effect of intratracheal administration is better.
【作者单位】：吉林大学第一临床医院麻醉科;
【基金】：国家自然科学基金资助课题(No.81141065,81271215)
【分类号】：R614

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