CAJ | 학술논문

目的提高对气道内利多卡因表面麻醉的认识.方法对1例淋巴瘤压迫气管患者气道内利多卡因表面麻醉后诱发抽搐的临床资料进行分析,结合文献对相关的不良反应、临床应用情况及药物代谢动力学进行回顾分析.结果患者为女性,19岁,因1个月来进行性呼吸困难而人住我院.1个月前曾因右颈部肿物于心胸外科行"颈部右甲状腺+上纵隔肿物切除术".术后病理证实为.下颈部、前上纵隔弥漫性大B细胞淋巴瘤,淋巴细胞性甲状腺炎".入院后考虑淋巴瘤复发压迫气管而引起患者呼吸困难.为确立诊断和评估气道情况,故行床边在高频喷射呼吸机辅助通气支持下行支气管镜检查.术前血生化检查肝、肾功能正常,术中采用滴注2%利多卡因的方式进行表面麻醉.支气管镜下见气管下段从隆突向上40 mm呈外压型狭窄,黏膜较粗糙.最狭窄处呈唇样狭窄.管径约4×10 mm.支气管镜可强行通过.左右主支气管开口受压狭窄.远端通畅未见新生物.术中利多卡因用量约300 mg,气管镜操作过程顺利,无明显气促加剧,操作过程中SPO2始终维持于92%以上.在准备行支架置入术时(约在第一次利多卡因气管滴注后的10 min),患者突发神志不清,全身强直性抽搐,经支气管镜引导下经口气管插管,球囊按压辅助通气,安定10 mg静推,5 min后患者抽搐停止,神志转清.心电监测见整个抽搐过程均呈窦性心律,心率约150次/min.抽搐停止后抽股动脉血测血浆利多卡因浓度.结果为7.76 mg/L.提示利多卡因中毒.结论利多卡因是支气管镜操作时最常用的局部麻醉药,临床应用时有不良反应报道.局部过快及超量吸收是导致利多卡因出现全身不良反应的主要原因.寻找到一种抑制利多卡因局部吸收的方法,是提高支气管镜操作的安全性的重要措施.
목적 제고대기도내리다잡인표면마취적인식.방법 대1례림파류압박기관환자기도내리다잡인표면마취후유발추휵적림상자료진행분석,결합문헌대상관적불량반응、림상응용정황급약물대사동역학진행회고분석.결과 환자위녀성,19세,인1개월래진행성호흡곤난이인주아원.1개월전증인우경부종물우심흉외과행"경부우갑상선+상종격종물절제술".술후병리증실위.하경부、전상종격미만성대B세포림파류,림파세포성갑상선염".입원후고필림파류복발압박기관이인기환자호흡곤난.위학립진단화평고기도정황,고행상변재고빈분사호흡궤보조통기지지하행지기관경검사.술전혈생화검사간、신공능정상,술중채용적주2%리다잡인적방식진행표면마취.지기관경하견기관하단종륭돌향상40 mm정외압형협착,점막교조조.최협착처정진양협착.관경약4×10 mm.지기관경가강행통과.좌우주지기관개구수압협착.원단통창미견신생물.술중리다잡인용량약300 mg,기관경조작과정순리,무명현기촉가극,조작과정중SPO2시종유지우92%이상.재준비행지가치입술시(약재제일차리다잡인기관적주후적10 min),환자돌발신지불청,전신강직성추휵,경지기관경인도하경구기관삽관,구낭안압보조통기,안정10 mg정추,5 min후환자추휵정지,신지전청.심전감측견정개추휵과정균정두성심률,심솔약150차/min.추휵정지후추고동맥혈측혈장리다잡인농도.결과위7.76 mg/L.제시리다잡인중독.결론 리다잡인시지기관경조작시최상용적국부마취약,림상응용시유불량반응보도.국부과쾌급초량흡수시도치리다잡인출현전신불량반응적주요원인.심조도일충억제리다잡인국부흡수적방법,시제고지기관경조작적안전성적중요조시.
Objective To increase the knowledge of airway topical anesthesia in lidocaine.Methods We analyzed a lymphoma patient which was induced convulsion by lidoeaine for topical anesthesia in airway,and retrospectively analyses the side-effect and clinical application and pharmacokinetics on the basis of the relevant documents.Results The patient,female,1 9 years old,was in hospital for progressive dyspnea during a month.For right trachelophyma she had accepted right cervical thyroid and superior mediastinum resection a month ago,and postoperatively pathology prompted diffuse large B-cell lymphoma in sub-cervical and anterosuperior mediastinum,lymphocytic thyroiditis.After hospitalization we considered that dyspnea was caused by the lymphoma which relapsed and oppressed the trachea.To establish the diagnosis and assessment the airway's condition the bronchoscopy was been done bedside the support of the high frequency jet ventilator.The liver and renal function were normal inspected by plasma biochemistry preoperative,and the method of airway topical anesthesia was instilling 2%lidocaine.The inferior segment of trachea about 40 mm from eminence was external pressure narrow,and the ITlueous membrane was asperity,and the extreme narrow segment was lip-like which caliber was 4×10 mm that the bronchoscopes could pass it by force.The right and left main bronchus opening was external pressure narrow and the distant part was unobstructed no neoplasm,The whole dosage of lidocaine was 300 mg.The operative procedure was successful and no short breath aggravated,and the SPO2 was above 92%.When the tracheal stent was repaired (about 10 min after the first drip of lidocaine) the patient was obnubilation and tonic seizure.After oral trachea cannula by bronchoscope guidance and assisted ventilation by compressing saccule and diazepam 10 mg IV,the convulsion stopped and the mind was clear 5 min later.The electrocardio-detection prompted that the heart rhythm was sinus rhythm and the HR was 150 times/min during the whole process.After the convulsion stopped the femoral artery plasma concentration of lidocaine was 7.76 mg/L which showed poisoning by lidocaine.Conclusions Lidocaine has been the most frequently used medicine for local anesthesia in flexible bronchoscopy.However,its severe side effects have been reported in clinical application.The primary reason of side effect is extra local absorption of lidocaine.It is the important intervention to increase the safety of bronchoscope which inhibits the local absorption of lidocaine.