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1%利多卡因硬膜外麻醉对人体动态运动时升压反应的影响。

The effect of epidural anaesthesia with 1% lidocaine on the pressor response to dynamic exercise in man.

作者信息

Friedman D B, Brennum J, Sztuk F, Hansen O B, Clifford P S, Bach F W, Arendt-Nielsen L, Mitchell J H, Secher N H

机构信息

Department of Anaesthesia, Rigshospitalet, University of Copenhagen, Denmark.

出版信息

J Physiol. 1993 Oct;470:681-91. doi: 10.1113/jphysiol.1993.sp019882.

Abstract
  1. In order to examine the sensitivity to local anaesthetics of afferent neural feedback from working muscle during dynamic exercise, sixteen subjects cycled for 12 min before and after epidural anaesthesia using 1% lidocaine. The presence of afferent neural blockade was verified by elimination of the blood pressure response to a cold pressor test, laser-induced evoked potentials and increases in pain detection and tolerance thresholds of the foot. Conversely, epidural anaesthesia had no effect on these variables in the unblocked skin areas or on electrically evoked potentials in blocked or unblocked skin. 2. During dynamic exercise, heart rate increased as did mean arterial pressure and cardiac output. Mean arterial pressure remained at the exercise level during post-exercise ischaemia, but heart rate and cardiac output decreased while total peripheral resistance increased. Epidural anaesthesia did not significantly affect these variables during rest, dynamic exercise, post-exercise ischaemia or recovery. 3. The results of this study show that, in order to affect blood pressure during dynamic exercise, epidural anaesthesia must block the pressor response to post-exercise ischaemia. The implication of these data is that complete or almost complete block of group III and/or group IV muscle afferents is necessary to inhibit the pressor response to dynamic exercise in man.
摘要
  1. 为了研究动态运动期间工作肌肉传入神经反馈对局部麻醉药的敏感性,16名受试者在使用1%利多卡因进行硬膜外麻醉前后分别进行了12分钟的骑行。通过消除冷加压试验的血压反应、激光诱发的诱发电位以及足部疼痛检测和耐受阈值的升高来证实传入神经阻滞的存在。相反,硬膜外麻醉对未阻滞皮肤区域的这些变量或对阻滞或未阻滞皮肤的电诱发电位没有影响。2. 在动态运动期间,心率、平均动脉压和心输出量均增加。运动后缺血期间平均动脉压保持在运动水平,但心率和心输出量下降,而总外周阻力增加。硬膜外麻醉在休息、动态运动、运动后缺血或恢复期间对这些变量没有显著影响。3. 本研究结果表明,为了在动态运动期间影响血压,硬膜外麻醉必须阻滞对运动后缺血的升压反应。这些数据表明,完全或几乎完全阻断Ⅲ类和/或Ⅳ类肌肉传入神经对于抑制人体对动态运动的升压反应是必要的。

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