摘要
目的 :观察普鲁卡因静脉复合麻醉 (IPA)与高铁血红蛋白 (MHb)血症出现的相关性。方法 :选择 ASA ～ 级择期手术的全麻患者 30例 ,随机分为 IPA组 ( 组 ) 2 0例 ,芬太尼组 ( 组 ) 10例 ,静脉快速诱导气管内插管 ,机械通气。麻醉维持 组用 2 %普鲁卡因、芬太尼、琥珀胆碱 , 组用 5 %葡萄糖代替普鲁卡因 ;术中监测 BP、 MAP、 ECG、 Sp O2 、Pet CO2 。结果 : 组上述参数稳定 ; 组 Sp O2 下降 14例 ,降至 93%以下并使用亚甲蓝治疗 9例 (2例紫绀 ,1例心率不齐 ) ,两组相比 P <0 .0 0 1,Sp O2 下降时普鲁卡因平均用量为 (3.17± 0 .48) g,平均总用量 (5 .75± 1.18) g;亚甲蓝治疗后Sp O2 回升至正常时间为 (2 8.44± 6 .6 5 ) m in。结论 :IPA致不同程度的 MHb症高达 5 0 %左右 ,发生机理为 IPA时普鲁卡因在体内的活性降解产物催化 Hb氧化为 MHb,可用氧化还原剂亚甲蓝逆转。
Objective:To investigate the relationship between the intravenous procaine anesthesia(IPA) and the appearance of Metahemoglobin(MHb) Methods:30 cases(ASA Ⅰ~Ⅱ) undergoing general anesthesia were randomly divided into two groups Two groups were induced with a rapid induction Group Ⅰ(20 cases) was maintained with procaine,fentanyl and suxamethonium Group Ⅱ(10 cases) was maintained with 5% glucose solute,fentanyl and suxamethonium The Bp,MAP,SpO 2,P ET CO 2 were monitored during the anesthesia course Results:The SpO 2 of 14 cases in group Ⅰ decreased significantly,9 cases of them(two cases were purple,one case was irregular) decreased below 93% and were treated with methylene blue There were no changes of SpO 2 in group Ⅱ There was significantly difference between two groups in the changes of SpO 2(P<0 01) The average dose that began to cause the decrease of SpO 2 was 3 17±0 48g The average total dose was 5 75±1 18g It took 28 44±6 65 minutes to return to normal level of SpO 2 after treated with methylene blue Conclusion:The syndrome of MHb caused by IPA was about 50% The activated catabolism of procaine during the IPA made the Hb oxygenated and became MHb,and the procedure of these changes could be reversed by the oxygen reducing agent methylene blue
出处
《广西医学》
CAS
2000年第1期50-51,共2页
Guangxi Medical Journal
