腎上腺素與利多卡因對開顱術患者血流動力學的影響_《華西醫學》

作者：

孫燕 , 張璟瑜 ,  李羽

四川大學華西醫院麻醉科（成都，610041）;

關鍵詞：

腎上腺素/利多卡因混合液開顱術頭皮浸潤法血壓流動力學

DOI：

CNKI: 51-1356/R.20120214.1531.040

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目的　觀察不同濃度腎上腺素與利多卡因混合液頭皮浸潤注射對開顱術患者血流動力學的影響。方法　選取2010年5月－10月80例顱內腫瘤患者，隨機分成4組，行1%利多卡因溶液混合不同濃度的腎上腺素16 mL頭皮浸潤注射。腎上腺素濃度：A組2.5 μg/mL、B組5.0 μg/mL、C組7.5 μg/mL、D組10.0 μg/mL。記錄注射前（T0）、注射后5 min內（T1-10）心率（HR）、平均動脈壓（MAP）、收縮壓（SBP）、舒張壓（DBP），根據各時段的MAP最低值和最高值，計算MAP的降低率和升高率，計數各組MAP下降10%以內、10%～20%和20%以上的例數。結果　 C組的MAP下降例數最多且MAP下降率最高，與其他組間比較差異有統計學意義（P＜0.05）。組內比較，C組MAP、SBP在1.5、2.0、2.5 min時、DBP在2 min時和D組MAP和DBP在1.5、2.0 min時下降差異有統計學意義（P＜0.05）。4組血壓下降的同時伴HR增快，但HR組間差異無統計學意義（P＞0.05）。結論　低濃度的腎上腺素與10%利多卡因混合液用于開顱術患者頭皮浸潤注射時可導致血壓下降。

引用本文： 孫燕,張璟瑜,李羽. 腎上腺素與利多卡因對開顱術患者血流動力學的影響. 華西醫學, 2012, 27(2): 245-249. doi: CNKI: 51-1356/R.20120214.1531.040 復制

1.	楊建軍, 王忠云, 沈錦春, 等. 鼻內窺鏡手術中局部浸潤麻醉時腎上腺素引起的心血管反應[J]. 江蘇醫藥, 2005, 31(11): 865-867.
2.	楊建軍, 劉紅軍, 蘇中宏, 等. 利多卡因混合不同劑量腎上腺素局部浸潤麻醉對全麻下鼻內窺鏡手術患者血液動力學的影響[J]. 中華麻醉學雜志, 2006, 26(5): 389-393.
3.	Muralidhar K, Bhanumurthy S. Attenuation of cardiovascular response to subcutaneous adrenaline in neurosurgical patients[J]. Br J Anaesth, 1992, 68(3): 264-267.
4.	胡益民, 李建生, 張轉, 等. 淺全身麻醉減少頭皮浸潤注射腎上腺素引起的血壓下降[J]. 醫學研究生學報, 2008, 21(6): 607-610.
5.	Misra S, Koshy T, Suneel PR, et al. Oral clonidine attenuates the fall in mean arterial pressure due to scalp infiltration with epinephrine-lidocaine solution in patients undergoing craniotomy: a prospective, randomized, double-blind, and placebo controlled trial[J]. J Neurosurg Anesthesiol, 2009, 21(4): 297-301.
6.	Moss J, Glick D. The autonomic nervous system[M]//Miller RD, Miller’s Anesthesia. 6th ed. Edinburgh: Churchill Livingstone, 2005: 617-678.
7.	Murthy HS, Rao GS. Cardiovascular responses to scalp infiltration with diferent concentrations of epinephrine with or without lidocaine during cranlotomy[J]. Anesth Analg, 2001, 92(6): 1516-1519.
8.	Phillips S, Hutchinson SE, Bayly P, et al. Adrenaline-induced hypotension in neurosurgery[J]. Br J Anaesth, 1993, 70(6): 687-688.
9.	John G, Low JM, Tan PE, et al. Plasma eatecholamine levels during functional endoscopic sinus surgery[J]. Clin Otolaryngol Allied Sci, 1995, 20(3): 213-215.
10.	Homma Y, Ichinohe T, Kaneko Y. Oral mucosal blood flow,plasma epinephrine and hemodynamics responses after injection of lidocaine with epinephrine during midazolam sedation and isoflurane anaesthesia[J]. Br J Anaesth, 1999, 82(4) : 570-574.
11.	Yang JJ, Cheng HL, Shang RJ, et al. Hemodynamic changes due to infiltration of the scalp with epinephrine-containing lidocaine solution: a hypotensive episode before craniotomy[J]. J Neurosurg Anesthesiol, 2007,19(1): 31-37.
12.	Enlund M, MentelI O, Krekmanov L. Unintentional hypotension from lidocaine infiltration during orthognathic surgery and general anaesthesia[J]. Acta Anaesthesiol Scand, 200l, 45(3): 294-297.
13.	Moss J, Rein CL. The autonomic nervous system[M]//Miler RD. Anesthesia. 5th ed. New York: Churchill Livingstone, 2000: 523-577.
14.	Cotton BR, Henderson HP, Achola KJ, et al. Changes in plasma catecholamine concentrations following infiltration with large volumes of local anaesthetic solution containing adrenaline[J]. Br J Anaesth, 1986, 58(6): 593-597.
15.	Young WL, Ornstein E. Cerebral and spinal cord flow[M]//Cottrell JE, Smith DS. Anesthesia and neurosurgery. St.Louis: Mosby, 1994: 17-58.

1. 楊建軍, 王忠云, 沈錦春, 等. 鼻內窺鏡手術中局部浸潤麻醉時腎上腺素引起的心血管反應[J]. 江蘇醫藥, 2005, 31(11): 865-867.
2. 楊建軍, 劉紅軍, 蘇中宏, 等. 利多卡因混合不同劑量腎上腺素局部浸潤麻醉對全麻下鼻內窺鏡手術患者血液動力學的影響[J]. 中華麻醉學雜志, 2006, 26(5): 389-393.
3. Muralidhar K, Bhanumurthy S. Attenuation of cardiovascular response to subcutaneous adrenaline in neurosurgical patients[J]. Br J Anaesth, 1992, 68(3): 264-267.
4. 胡益民, 李建生, 張轉, 等. 淺全身麻醉減少頭皮浸潤注射腎上腺素引起的血壓下降[J]. 醫學研究生學報, 2008, 21(6): 607-610.
5. Misra S, Koshy T, Suneel PR, et al. Oral clonidine attenuates the fall in mean arterial pressure due to scalp infiltration with epinephrine-lidocaine solution in patients undergoing craniotomy: a prospective, randomized, double-blind, and placebo controlled trial[J]. J Neurosurg Anesthesiol, 2009, 21(4): 297-301.
6. Moss J, Glick D. The autonomic nervous system[M]//Miller RD, Miller’s Anesthesia. 6th ed. Edinburgh: Churchill Livingstone, 2005: 617-678.
7. Murthy HS, Rao GS. Cardiovascular responses to scalp infiltration with diferent concentrations of epinephrine with or without lidocaine during cranlotomy[J]. Anesth Analg, 2001, 92(6): 1516-1519.
8. Phillips S, Hutchinson SE, Bayly P, et al. Adrenaline-induced hypotension in neurosurgery[J]. Br J Anaesth, 1993, 70(6): 687-688.
9. John G, Low JM, Tan PE, et al. Plasma eatecholamine levels during functional endoscopic sinus surgery[J]. Clin Otolaryngol Allied Sci, 1995, 20(3): 213-215.
10. Homma Y, Ichinohe T, Kaneko Y. Oral mucosal blood flow,plasma epinephrine and hemodynamics responses after injection of lidocaine with epinephrine during midazolam sedation and isoflurane anaesthesia[J]. Br J Anaesth, 1999, 82(4) : 570-574.
11. Yang JJ, Cheng HL, Shang RJ, et al. Hemodynamic changes due to infiltration of the scalp with epinephrine-containing lidocaine solution: a hypotensive episode before craniotomy[J]. J Neurosurg Anesthesiol, 2007,19(1): 31-37.
12. Enlund M, MentelI O, Krekmanov L. Unintentional hypotension from lidocaine infiltration during orthognathic surgery and general anaesthesia[J]. Acta Anaesthesiol Scand, 200l, 45(3): 294-297.
13. Moss J, Rein CL. The autonomic nervous system[M]//Miler RD. Anesthesia. 5th ed. New York: Churchill Livingstone, 2000: 523-577.
14. Cotton BR, Henderson HP, Achola KJ, et al. Changes in plasma catecholamine concentrations following infiltration with large volumes of local anaesthetic solution containing adrenaline[J]. Br J Anaesth, 1986, 58(6): 593-597.
15. Young WL, Ornstein E. Cerebral and spinal cord flow[M]//Cottrell JE, Smith DS. Anesthesia and neurosurgery. St.Louis: Mosby, 1994: 17-58.

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腎上腺素與利多卡因對開顱術患者血流動力學的影響

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《華西醫學》

腎上腺素與利多卡因對開顱術患者血流動力學的影響

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