頸部硬脊膜外麻醉對肺功能的影響

EFFECTS OF LIDOCAINE CERVICAL EPIDURAL BLOCKADE ON RESPIRATORY FUNCTION

黃志宏(Cih Hung Huang) ； 許榮廉(Jung-Lien Hsu) ； 陳文昇(Wen-Sheng Chen) ； 張忠良 ； 陳慧娟

《Acta Anaesthesiologica Sinica》 28卷3期 (1990/09) Pp. 311-316

摘要

從1988年10月至1989年9月，我們選擇50位骨科上放手術病例，給予頸部硬脊膜外麻醉，並評估其肺功能的變化。使用麻醉藥劑為plain 2% Lidocaine。全部注入量：12mL。分別於麻醉前，及麻醉後20、50、105分鐘，記錄其肺功能數值，並做動脈血氣體分析結果顯示，麻醉範固自C_3至T_3。麻醉過程中，血壓均於105-135/70-90mm Hg以內，心跳速率略緩慢，但心電圖監視無特殊變化。動脈血你體分析，於麻醉從20分鐘，有輕微呼吸性酸中毒，但無呼吸窘迫現象。肺功能檢查則呈現輕微限制性肺功能異常。而麻醉從50、105分鐘測量的肺功能數值，則已回復至和baseline相距9個百分點以內。

關鍵字

Cervical epidural anesthesia ； Pulmonary function

並列摘要

Cervical epidural anesthesia with 2% lidocaine has been shown to reduce ventilatory capacity in patients with normal lungs by Dr. Bromage. lt is important to evaluate the respiratory effect of this technique which may induce intercostal and phrenic nerver paralysis. After institutional approval and informed content had been obtained, 50 patients undergoing OR & IF of upper limbs, mean age 24±4 yrs mean weight 65±6 kg, ASA status I-II without preoperative pulmonary dysfunction were studied . C7-T1 intervertebral space was indentified by the hanging-drop technique using a 16G Tuochy neele. A catheter was inserted cranially to a distance of 12 cm. Pulmonary function measurement and arterial blood gas data were obstainee before and 20', 50', 105' min after injection of 12 ml 2% plain lidocaine. The anesthesia levels were between C3-T3 and obstained at 13±2 min. Mean arterial blood gas analysis showed mild respiratory acidosis at 20 min (PaCO_2: 46.0±3.5 mmHg). The measured values of IVC, VC, FVC, FEY_1, PEF, when compaired with control values were decreased over 15.60% of control values and 20% of predicted data at 20 min. The ratio of FEV_1, VC, FEV_1/FVC were still within normal limit (＞80%). (Table 1) The result was signficantly compatible to the criteria of mild type of pulmonary function test. No respiratory distress was complained of and only cause little change of arterial blood gas. Without total spinal, intravenous anesthesia or preoperative pulmonary dysfunction, the reduced lung volumes & capacities may be resulted from partially paralytic intercostal muscles and diaphragm innervated by throacic intercostal never & phrenic nerver and patients with normal lungs can tolerate this change well, lnt we should be particularly careful for patients with old age or preexisting lung diseases.