Gallart L, Gea J, Aguar M C, Broquetas J M, Puig M M
Department of Anesthesiology, Hospital Universitari del Mar, Barcelona, Spain.
Anesthesiology. 1995 Jul;83(1):48-55. doi: 10.1097/00000542-199507000-00006.
Several reports suggest that interpleural local anesthetics may have deleterious effects on respiratory function. The current study investigated the effects of interpleural bupivacaine on human respiratory muscles and lung function.
Thirteen patients (55 +/- 4 yr old) with normal respiratory function and scheduled for cholecystectomy entered the study before surgery. Respiratory parameters were compared before and after the interpleural administration of 20 ml 0.5% bupivacaine plus 1:200,000 epinephrine while patients were supine; we evaluated breathing pattern, dynamic and static lung volumes, airway conductance, maximal inspiratory pressures (at the mouth; at the esophagus [Pessniff]; at the abdomen [Pgasniff]; and transdiaphragmatic [Pdisniff]), functional reserve (tension-time index) of the diaphragm, and maximal expiratory pressures (at the mouth; at the esophagus [Pescough]; and at the abdomen [Pgacough]). Hemoglobin oxygen saturation by pulse oximetry, heart rate, and mean arterial pressure were continuously monitored.
Respiratory rate (15 +/- 1 to 19 +/- 1 breaths/min; P < 0.01) and heart rate (78 +/- 3 to 83 +/- 3 beats/min; P < 0.01) were slightly increased. Dynamic and static lung volumes, airway conductance, hemoglobin saturation, and the remaining breathing pattern parameters were unchanged. Regarding respiratory muscles, maximal inspiratory pressure at the mouth, Pessniff, and tension-time index of the diaphragm did not change. Pdisniff decreased slightly (102 +/- 10 to 92 +/- 10 cmH2O; P < 0.05) because of a change in Pgasniff (24.2 +/- 7.4 to 18.4 +/- 6.8 cmH2O; P < 0.05). Maximal expiratory pressure at the mouth remained unaltered, but Pgacough decreased (108 +/- 10 to 92 +/- 8 cmH2O; P < 0.01), and Pescough showed a trend to decrease (92 +/- 13 to 78 +/- 10 cmH2O; P = 0.074).
In our experimental conditions, interpleural bupivacaine did not significantly change lung function or inspiratory muscle strength but induced a slight decrease in abdominal muscle strength. Although this effect was minimal, its clinical relevance needs to be evaluated further in patients with impaired respiratory function.
多项报告表明，胸膜间局部麻醉药可能对呼吸功能产生有害影响。本研究调查了胸膜间布比卡因对人体呼吸肌和肺功能的影响。
13例呼吸功能正常且计划行胆囊切除术的患者（年龄55±4岁）在手术前进入本研究。在患者仰卧位时，比较胸膜间给予20 ml 0.5%布比卡因加1:200,000肾上腺素前后的呼吸参数；我们评估了呼吸模式、动态和静态肺容量、气道传导率、最大吸气压力（口腔处；食管处[Pessniff]；腹部处[Pgasniff]；以及经膈肌处[Pdisniff]）、膈肌的功能储备（张力 - 时间指数）以及最大呼气压力（口腔处；食管处[Pescough]；以及腹部处[Pgacough]）。通过脉搏血氧饱和度仪持续监测血红蛋白氧饱和度、心率和平均动脉压。
呼吸频率（从15±1次/分钟增加到19±1次/分钟；P < 0.01）和心率（从78±3次/分钟增加到83±3次/分钟；P < 0.01）略有增加。动态和静态肺容量、气道传导率、血红蛋白饱和度以及其余呼吸模式参数均未改变。关于呼吸肌，口腔处的最大吸气压力、Pessniff以及膈肌的张力 - 时间指数未发生变化。由于Pgasniff的改变（从24.2±7.4 cmH₂O降至18.4±6.8 cmH₂O；P < 0.05），Pdisniff略有下降（从102±10 cmH₂O降至92±10 cmH₂O；P < 0.05）。口腔处的最大呼气压力保持不变，但Pgacough下降（从108±10 cmH₂O降至92±8 cmH₂O；P < 0.01），并且Pescough有下降趋势（从92±13 cmH₂O降至78±10 cmH₂O；P = 0.074）。
在我们的实验条件下，胸膜间布比卡因并未显著改变肺功能或吸气肌力量，但导致腹部肌肉力量略有下降。尽管这种影响很小，但其临床相关性仍需在呼吸功能受损的患者中进一步评估。
