Wang Jun, Yao Lan, Zhang Ning, Suo Libin, Li Hongpei, Wei Yue, Cha Peng, Liang Zheng, Liu Kunpeng
Department of Anesthesiology, Peking University International Hospital, Beijing 102206, China.
Department of Thoracic Surgery, Peking University International Hospital, Beijing 102206, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2024 Oct 18;56(5):890-895. doi: 10.19723/j.issn.1671-167X.2024.05.021.
To compare the effects of unilateral thoracic paravertebal block with lidocaine on hemodynamic and the level of consciousness during double lumen endotracheal intubation.
From June to october 2021, a total of 40 patients American Society of Anesthesiologists (ASA) physical status Ⅰ-Ⅱ, aged 19-65 years, scheduled for elective thoracic sugeries in Peking University International Hospital block with under general anesthesia requiring orotracheal intubation were recruited and divided into two groups: The double-lumen endobronchial intubation (group C) and double-lumen endobronchial intubation after thoracic paravertebal block with lidocaine (group P). After an intravenous anesthetic induction, the orotracheal double-lumen intubation was performed using a Macintosh direct laryngoscopy, respectively. Invasive blood pressure (BP) and heart rate (HR) were recorded before and after anesthetic induction, immediately after intubation and 5 min after intubation with 1-minute interval and the intubation time was also noted. Rate-pressure product (RPP) were calculated.
After anesthetic induction, BP and RPP in the two groups decreased significantly compared with their preinduction values. As comparison with their postinduction values, the orotracheal intubation in the two groups caused significant increases in BP, HR and RPP. Diastolic blood pressure (DBP) and mean arterial pressure (MAP) increased significantly and lasted for 1-minute in group C compared with the baseline values. Systolic blood pressure (SBP) was not significant change and DBP increased significantly immediately after intubation in group P.HR of both groups after intubation were significantly higher than their baseline values and lasted for 4 min in group C, HR increased significantly immediately after intubation in group P. SBP, DBP, MAP, HR and RPP after intubation in group P were significantly lower than those of group C during the observation period. The value of BIS was similar between the two groups. Compared with group C, the incidence of SBP greater than 30% and RPP greater than 22 000 was significantly lower in group P in the observation period, and no patient in group P developed RPP greater than 22 000. At the end of the incidence of SBP less than 30% of the basal value and HR less than 30% of the baseline, no severe bradycardia occurred in both groups.
During double-lumen endobronchial intubation, unilateral thoracic paravertebal block with lidocaine can provide less hemodynamic response and level of conscionsness.
比较利多卡因单侧胸段椎旁阻滞对双腔气管插管期间血流动力学及意识水平的影响。
选取2021年6月至10月在北京大学国际医院择期行胸科手术、美国麻醉医师协会（ASA）身体状况Ⅰ-Ⅱ级、年龄19-65岁、需在全身麻醉下行口气管插管的40例患者，分为两组：双腔支气管插管组（C组）和利多卡因胸段椎旁阻滞后双腔支气管插管组（P组）。静脉麻醉诱导后，分别采用麦氏直接喉镜行口气管双腔插管。记录麻醉诱导前、诱导后、插管即刻、插管后5分钟（间隔1分钟）的有创血压（BP）和心率（HR），并记录插管时间。计算速率压力乘积（RPP）。
麻醉诱导后，两组的BP和RPP均较诱导前显著降低。与诱导后值相比，两组口气管插管均导致BP、HR和RPP显著升高。与基线值相比，C组舒张压（DBP）和平均动脉压（MAP）显著升高并持续1分钟。P组插管后收缩压（SBP）无显著变化，DBP即刻显著升高。两组插管后的HR均显著高于基线值，C组持续4分钟，P组插管后HR即刻显著升高。观察期内P组插管后的SBP、DBP、MAP、HR和RPP均显著低于C组。两组的脑电双频指数（BIS）值相似。与C组相比，观察期内P组SBP升高大于30%和RPP大于22000的发生率显著降低，P组无患者RPP大于22000。在SBP低于基础值30%和HR低于基线30%的发生率结束时，两组均未发生严重心动过缓。
在双腔支气管插管期间，利多卡因单侧胸段椎旁阻滞可提供较小的血流动力学反应和意识水平。
