文章摘要
静脉注射利多卡因对丙泊酚抑制人工流产术扩张宫颈时体动半数有效浓度的影响
Effect of intravenous lidocaine on the median effective concentration of propofol in suppressing body movement during cervical dilation in induced abortion
  
DOI：10.12089/jca.2024.04.003
中文关键词: 利多卡因  丙泊酚  人工流产术  半数有效剂量  靶控输注
英文关键词: Lidocaine  Propofol  Induced abortion  Median effective concentration  Target controlled infusion
基金项目:广东省教育厅普通高校重点科研项目（2022ZDZX2007）；佛山市“十四五”重点专科资助项目（FSZD145048）；南方医科大学顺德医院临床研究启动计划项目（CRSP2022012）；南方医科大学顺德医院青年人员科研启动项目（SRSP2023010）
作者单位E-mail
唐镇宇 528300,佛山市,南方医科大学顺德医院麻醉科  
万婷婷 528300,佛山市,南方医科大学顺德医院麻醉科  
王冠华 528300,佛山市,南方医科大学顺德医院麻醉科  
邱文蕊 528300,佛山市,南方医科大学顺德医院麻醉科  
张奕文 528300,佛山市,南方医科大学顺德医院麻醉科  
陈汉文 528300,佛山市,南方医科大学顺德医院麻醉科  
吕婷敏 528300,佛山市,南方医科大学顺德医院麻醉科 lv_yumiko@163.com 
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中文摘要:
      
目的：探究静脉注射利多卡因对丙泊酚施耐德（Schnider）模型靶控输注（TCI） 抑制人工流产术扩张宫颈时体动半数有效浓度（EC50）的影响。
方法：选择自愿要求终止妊娠的初次人工流产患者46例，年龄 18～35岁，妊娠6～9周，BMI 18～25 kg/m2，ASA Ⅰ或Ⅱ级。根据计算机生成的随机序列分为两组:利多卡因组（L组，n=25）和生理盐水组（C组，n=21）。L组静脉注射利多卡因1 mg/kg，C组静脉注射等容量的生理盐水。采用Schnider模型TCI丙泊酚，初始效应室靶浓度设为4.0 μg/ml，依据Dixon序贯法，如在扩张宫颈时发生2级及以上体动反应，为阳性反应，则下一例升高一个浓度梯度，否则降低一个浓度梯度，相邻浓度梯度为0.5 μg/ml。连续出现7个阳性反应拐点时终止研究。采用Probit回归分析计算两组丙泊酚抑制人工流产术扩张宫颈时体动的EC50和95%有效浓度（EC95）及其95%可信区间（CI）。记录意识消失时间、苏醒时间、丙泊酚使用量和宫颈扩张效果，丙泊酚注射痛和术后15 min VAS疼痛评分，围术期低氧血症、低血压、术后恶心呕吐和头晕等不良反应的发生情况。
结果：L组丙泊酚抑制人工流产术扩张宫颈时体动的EC50为3.82 μg/ml（95％CI 3.59～4.03 μg/ml），EC95为4.25 μg/ml（95％CI 4.04～5.10 μg/ml）。C组丙泊酚抑制人工流产术扩张宫颈时体动的EC50为4.09 μg/ml（95％CI 3.71～4.41 μg/ml），EC95为4.65 μg/ml（95％CI 4.36～6.48 μg/ml）。与C组比较，L组丙泊酚EC50明显降低，丙泊酚使用量明显减少，宫颈扩张总有效率明显升高，丙泊酚注射痛和低氧血症发生率明显降低（P＜0.05）。
结论：静脉注射利多卡因1 mg/kg可降低Schnider模型TCI丙泊酚抑制人工流产术扩张宫颈时体动的EC50，减少丙泊酚使用量，降低静脉注射痛发生率，宫颈扩张效果好，不良反应少。
英文摘要:
      
Objective: To investigate the effect of intravenous lidocaine on the median effect concentration (EC50) for the suppression of body movement during cervical dilation in artificial abortion procedures under propofol target-controlled infusion (TCI) using the Schnider model.
Methods: Forty-six patients were those seeking their initial artificial abortion, aged 18-35 years, with a gestational period of 6-9 weeks, BMI 18-25 kg/m2, and ASA physical status Ⅰ or Ⅱ. Participants were randomly divided into two groups: lidocaine (group L, n = 25) and saline (group C, n = 21), determined by a sequence created by a computer. Group L was administered lidocaine intravenously at a dosage of 1 mg/kg, whereas group C was given a similar amount of saline. The Schnider TCI model was used to administer propofol, starting with an effect-site concentration of 4.0 μg/ml. According to the Dixon sequential method, a body movement reaction of grade 2 or higher during cervical dilation was classified as a positive response, necessitating an increase in the concentration gradient by one level for the subsequent case. Conversely, if the reaction was below grade 2, the concentration gradient should be decreased by one level for the next case. The adjacent concentration gradients were 0.5 μg/ml. The study would be terminated if there were 7 consecutive positive responses. The EC50, the 95% effective concentration (EC95), and the corresponding 95% confidence interval (CI) for inhibiting body movement by propofol during cervical dilation in the two groups were determined using probit regression analysis. Patient data including time to loss of consciousness, recovery time, the amount of propofol used for the procedure, cervical dilation effect, propofol injection pain, and VAS pain score at 15 minutes post-operation were recorded. Additionally, note the occurrence of hypoxemia and perioperative hypotension, as well as postoperative adverse reactions such as nausea, vomiting, and dizziness were recorded.
Results: In group L, the EC50 and EC95 of propofol in suppressing body movement during cervical dilation was 3.82 μg/ml (95% CI 3.59-4.03 μg/ml) and 4.25 μg/ml (95% CI 4.04-5.10 μg/ml). In group C, the EC50 and EC95 of propofol in suppressing body movement during cervical dilation were 4.09 μg/ml (95% CI 3.71-4.41 μg/ml) and 4.65 μg/ml (95% CI 4.36-6.48 μg/ml). Compared with group C, group L exhibited a notable decrease in the EC50 of propofol, along with a significant reduction in propofol dosage, the total effective rate of cervical dilatation was also significantly improved, while the incidence of propofol injection pain and hypoxemia was significantly decreased (P < 0.05).
Conclusion: Administering intravenous lidocaine at a dosage of 1 mg/kg can reduce the EC50 of propofol required to suppress body movement during cervical dilation in induced abortion under the Schnider TCI model, which decreases the amount of propofol needed, reduces the incidence of injection pain, improves the effect of cervical dilation, and results in fewer adverse reactions.
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