摘要
目的观察大剂量利多卡因全静脉麻醉对心胸外科手术患者心肌酶和心肌收缩力的影响。方法①心肌酶的观察 :将 60例成人ASAⅡ～Ⅲ级普通胸科 (普胸 )手术随机分成 3组 ,每组 2 0例。Ⅰ组为观察组 ,麻醉诱导和麻醉维持均选用利多卡因 ,伍用地西泮、芬太尼等 ;Ⅱ、Ⅲ组为对照组。 3组均检测麻醉开始前、手术结束时和术后 3 6小时的心肌酶谱 ,用t检验比较变化情况。②心肌收缩力的观察 :选择房间隔缺损修补术 15例、室间隔缺损修补术 43例 ,采用普胸Ⅰ组的麻醉方式及晶体冷停跳液灌注转流方式 ,观察心脏复跳后心肌收缩力强弱。结果①心肌酶谱 :术毕和术后 3 6小时Ⅰ组均高于Ⅱ组和Ⅲ组 (P <0 0 5 ) ;同组术毕和术后 3 6小时与术前比较存在显著性差异 (P <0 0 1和P <0 0 5 ) ;同组术后 3 6小时与术毕比较亦有显著性差异 (P <0 0 5 )。②心肌心缩力 :房间隔缺损修补术心脏复跳后发生轻度心肌收缩无力 6例、重度 3例 ;室间隔缺损修补术发生轻度心肌收缩无力 17例、重度 10例。结论静脉麻醉剂可预防或减轻大剂量利多卡因中毒所致的骨骼肌抽搐 。
Objective To observe the influences of excessive dosage of Lidocaine in intravenous anesthesia on myocardial enzymes and cardiac contractility. Methods ①60 patients undergoing thoracic surgery in ASA (American Society of anesthesiologists) grade Ⅱ～Ⅲ were randomly divided into three groups with 20 subjects in each group.Group Ⅰ served as study group and the other two as controls.Anesthesia in Group Ⅰ was induced and maintained with intravenous Lidocain,Diazepam and Fentanyl.In Group Ⅱ and group Ⅲ,anesthesia was induced with intravenous Diazepam,Sodium hydroxybuteate,Fentanyl,Propofol and Scolin.The activities of glutamic oxalacetic transaminase(GOT),creatine kinase(CK),lactic dehydrogenase(LDH),α hydroxybutyric dehydrogenase(HBDH) and creatine kinase musclebrain hybrid(CK MB) in each group were detected preoperatively,at the end of operation and 36 hours after the operation respectively.The results were compared among the three groups.②15 patients undergoing repair of atrial spetal defect (n=15) and 43 on repair of ventrcular defect were receiving the same anethesia as the Group Ⅰ and perfused with crystal cold stop jump liquid.Cardiac contractility was assessed when the heart beat recovered. Results ①At the end of operation and 36 hours after it,levels of all the myocardial enzymes in Group Ⅰ were higher than those in Group Ⅱ and Group Ⅲ(P<0 05);within each group,their levels at the end of operation and 36 hour following the operation were significantly different from those before the operation (P<0 01,P<0 05);there was also a significant difference between those before and after the operation(P<0 05).②Regarding cardiac contractility,slight insufficiency of contractility happened to 6 patients and servere type to 3 undergoing repair of atrial spetal defect;sligh type to 17 on repair of ventricular defect whereas severe type to 10 patients. Conclusions The intravenous anesthetics could relieve and prevent muscular spasm induced by large dosage of Lodocain but could not treat and prevent the toxic reaction of excessive dosages of Lidocaine on myocardium.
出处
《临床误诊误治》
2004年第7期457-459,共3页
Clinical Misdiagnosis & Mistherapy
关键词
麻醉
静脉内
利多卡因
心肌酶
心肌收缩
手术并发症
研究
Anesthesia,intravenous
Lidocain
Myocardial enzymes
Cardiac contractility
Operative complication
Research
