McAlpine L G, Thomson N C
Department of Respiratory Medicine, Western Infirmary, Glasgow, Scotland.
Chest. 1989 Nov;96(5):1012-5. doi: 10.1378/chest.96.5.1012.
Inhaled topical lidocaine, used to produce anesthesia of the respiratory tract prior to bronchoscopy, may cause bronchoconstriction in asthmatic patients. We investigated whether the degree of histamine airway responsiveness would predict the development and extent of lidocaine-induced bronchoconstriction in 20 asthmatic patients. The provocation concentration of histamine producing a 20 percent fall in FEV1 (PC20) was measured. On a separate day, challenge with 6 ml 4 percent lidocaine (Xylocaine 4 percent topical) was performed. There was no correlation between the response to lidocaine and the histamine PC20. Five patients (25 percent) showed a fall in FEV1 of greater than 15 percent (max 42.1 percent). Three responders were rechallenged double-blind with the commercial 4 percent lidocaine preparation and with a 4 percent preservative-free lidocaine solution. There was no difference in the response to these two solutions. These results demonstrate that inhaled topical lidocaine induces bronchoconstriction in a significant proportion of patients with asthma. This response is not related to airway histamine responsiveness or to the preservative in the lidocaine preparation.
吸入性局部利多卡因常用于在支气管镜检查前对呼吸道进行麻醉，但可能会导致哮喘患者出现支气管收缩。我们研究了组胺气道反应性程度是否能预测20例哮喘患者中利多卡因诱导的支气管收缩的发生及程度。测量了使第一秒用力呼气容积（FEV1）下降20%时的组胺激发浓度（PC20）。在另一天，用6毫升4%利多卡因（4%赛罗卡因局部用）进行激发试验。利多卡因反应与组胺PC20之间无相关性。5例患者（25%）FEV1下降超过15%（最大为42.1%）。3例有反应者接受了4%市售利多卡因制剂和4%无防腐剂利多卡因溶液的双盲再激发试验。对这两种溶液的反应无差异。这些结果表明，吸入性局部利多卡因可使相当一部分哮喘患者发生支气管收缩。这种反应与气道组胺反应性或利多卡因制剂中的防腐剂无关。
