利多卡因健侧支气管表麻对单肺通气时低氧血症的防治

发布时间：2019-01-06 10:56

【摘要】：目的探讨单肺通气(OLV)过程中利多卡因支气管表麻对手术刺激后应激反应导致低氧血症的防治。方法选取择期行肺癌根治术患者40例,分为两组,每组20例,插入双腔支气管导管后,对照组经健侧支气管导管注入生理盐水2.5 m L,治疗组注入2%利多卡因2.5 m L,记录患者麻醉插管后(T0)、OLV开始(T1)、手术开始(T2)、OLV 15 min(T3)、OLV 30 min(T4)、OLV 60 min(T5)、关胸后(T6)各时点脉搏血氧饱和度(SpO2)、心率(HR)、平均动脉压(MAP)、肺顺应性(Cdyn)、气道峰压(Ppeak)以及尿量的变化;在OLV前、后及术毕行动脉血气分析,监测动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)。结果麻醉插管后、OLV后、手术刺激前,两组SpO2、HR、MAP、Cdyn、Ppeak均无明显变化(P0.05);手术刺激后,治疗组T2、T3、T4各点PaO2、SpO2高于对照组(P0.05);治疗组低氧血症的发生率明显低于对照组(P0.05);且低氧持续时间亦较对照组短(P0.05);两组患者PaCO2均在正常范围内,两组比较差异无统计学意义;治疗组Ppeak较对照组有所下降(P0.05);Cdyn优于对照组(P0.05);治疗组MAP在手术初始阶段较对照组稳定(P0.05),HR组间比较差异无统计学意义。结论 OLV期间,手术刺激引起血氧下降,利多卡因健侧表麻可有效减少应激反应,提高耐管时间,减轻低氧血症,维持血流动力学的稳定。该方法简便、易行,是OLV期间改善低氧血症的有效方法。
[Abstract]:Objective to investigate the prevention and treatment of hypoxemia caused by stress response of lidocaine bronchial surface anesthesia during single lung ventilation (OLV). Methods Forty patients undergoing radical resection of lung cancer were randomly divided into two groups: 20 patients in each group were treated with double lumen bronchial catheter, and the control group was injected with normal saline 2.5 mL through normal side bronchial catheter. 2% lidocaine was injected into 2% Lidocaine in the treatment group. After anesthesia intubation (T 0), OLV (T 1) and surgery (T 2), OLV 30 min (T 4), OLV 60 min (T 5), the patients in the treatment group were recorded after anesthesia intubation (T 0), OLV start (T 1) and operation began (T 2), OLV 15 min). Changes of pulse oxygen saturation (SpO2), mean arterial pressure of heart rate (HR), (MAP), pulmonary compliance (Cdyn), peak airway pressure (Ppeak) and urine volume at different time points after thoracic closure (T6); Arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2) were monitored before, after and after OLV. Results after anesthesia intubation, after OLV, there was no significant change in SpO2,HR,MAP,Cdyn,Ppeak in both groups before and after operation (P0.05), PaO2,SpO2 in treatment group was higher than that in control group (P0.05). The incidence of hypoxemia in the treatment group was significantly lower than that in the control group (P0.05), and the duration of hypoxia was also shorter than that in the control group (P0.05). The PaCO2 of the two groups was within the normal range, and there was no significant difference between the two groups. The Ppeak of the treatment group was lower than that of the control group (P0.05); Cdyn was better than that of the control group (P0.05); the MAP of the treatment group was stable compared with the control group at the initial stage of operation (P0.05), HR). Conclusion during OLV, the blood oxygen was decreased by operation stimulation. Lidocaine could effectively reduce stress reaction, increase the time of resistance to tube, alleviate hypoxemia and maintain hemodynamic stability. This method is simple and feasible and is an effective method to improve hypoxemia during OLV.
【作者单位】：中国医科大学附属盛京医院麻醉科;
【分类号】：R614

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