目的 观察乌拉地尔和利多卡因配伍对颈丛阻滞心血管应激反应是否有预防作用.方法 选择30例甲状腺类手术患者,随机分为三组,各10例.所有患者均以第4颈椎-针法阻滞,阻滞液为Ⅰ组0.25%罗哌卡因30 ml,Ⅱ组0.25%罗哌卡因+1%利多卡因混合液30 ml,Ⅲ组0.25%罗哌卡因+1%利多卡因+乌拉地尔0.4～0.5 mg/kg混合液30 ml.三组患者均常规鼻导管吸氧,切皮前静脉注射哌替啶50 mg和氟哌利多2.5 mg.持续监测心电图、脉搏氧饱和度(SpO2)、血压,并在各时点抽血查血浆去甲肾上腺素(NE)和肾上腺素(E)的含量.结果 Ⅲ组患者阻滞前各观察指标无变化(P＞0.05);Ⅰ组患者阻滞后5、10 min平均动脉压较阻滞前和Ⅲ组间有明显变化(P<0.01);Ⅱ组患者阻滞前后MAP有变化(P<0.05).血浆NE和E,Ⅰ组阻滞后较阻滞前和Ⅲ组间有变化(P<0.05),Ⅱ组变化无统计学意义.结论 乌拉地尔配伍利多卡因能有效预防颈丛阻滞心血管应激反应.%Objective To study the prevention effect of urapidil with lidocaine to the cardiovascular stress in the cervical plexus blockade patients. Methods Thirty patients undergoing thyroidectomy were randomly divided into three groups of ten ones of each. All the patients were anesthetized in the C4 block. Group Ⅰ with 0.25% ropivacaine 30 ml. Group Ⅱ were given 0.25% ropivation with 1% lidocaine combined altogether 30 ml. and the group Ⅲ were used 0.25% ropivacaine with I% lidocaine and urapidil 0.4 -0.5 mg/kg combined 30 ml. Oxygen was inhaled routinely through nasal tube during operation. Pethidine 50 mg and droperidol 2.5 mg were injected in the vein incision. The electrocardiogram, SpO2, blood pressure were monitored continually. The noradrenaline(NE) and adrenalin(E) plasm concentration were also messured. Results There were no significant differences in Group Ⅰ and Group Ⅱ (P ＞ 0.05),The changes of MAP af-ter 5 minutes and 10 minutes blockade in Group Ⅱ were significantly different than that in group Ⅲ (P < 0.01). The MAPs after block more lower than that before block. The serum NE and E level between preb - lock and post - block in Group Ⅰ were more different than that in Group Ⅲ (P < 0.05). Conclusions Stress responses can be prevented by urapi-dil and lidocaine during cervical plexus blockade.
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