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利多卡因静注过量引起严重中毒反应的病例较少见,国内有关文献报道尚少。我们在临床工作中收治1例因利多卡因过量引起严重反应的病人,现报告如下。 患者张某,男,50岁。住院号1358。在当地卫生所因把利多卡因50mg误看是500mg,而将2％利多卡因2.5支(25me)静脉注射,尚未注完即出现四肢抽搐,口吐白沫,于1992年3月4日来我院求治,门诊以抽搐原因待查(当时不知是利多卡因过量)急诊入院。 查体:急重病容,面部及全身紫绀,口吐白沫,四肢频繁抽搐。血压12/8kpa,心率130次/分,心音弱、律整,双肺底部可闻及水泡音,腹软。立即给氧,静注50％葡萄糖60毫升,毒毛旋花子甙K0.25mg,速尿20mg,肌注苯巴比妥及水合氯醛灌肠。1小时后,呼吸浅表继之停止,心音微弱、缓慢,心电图示加速性室性自搏心律.立即给予正压给氧,人工辅助呼吸,静注阿托品及异丙肾上腺素各1mg,约2分钟后恢复自主呼吸,心率110次/分,心电图示窦性心律,左前分支传导阻滞。3小时后,抽搐停止,口腔不再溢泡沫痰,双肺未闻及水泡音,继续给予补液、镇静,抚感染及对症治疗。第二日神志恢复正常,从急诊室转入普通病房。 讨论
Lidocaine intravenous overdose caused serious poisoning cases are rare, the domestic literature is still little reported. We in the clinical work admitted to a case of lidocaine overdose caused serious reactions in patients, are as follows. Zhang patients, male, 50 years old. Hospital number 1358. In the local health clinics because lidocaine 50mg erroneously see is 500mg, and 2% lidocaine 2.5 (25me) intravenous injection has not yet finished limbs convulsions, foaming at the mouth, on March 4, 1992 To our hospital for treatment, clinics to be checked because of convulsions (then I do not know is excessive lidocaine) emergency admission. Physical examination: critical illness, facial and systemic cyanosis, foaming at the mouth, frequent convulsions in extremities. Blood pressure 12 / 8kpa, heart rate 130 beats / min, weak heart, law, the lungs can smell the bottom and blisters sound, abdominal soft. Immediately to oxygen, intravenous injection of 50% glucose 60 ml, poisonous hair spinosad K0.25mg, furosemide 20mg, intramuscular phenobarbital and chloral hydrate enema. 1 hour later, the superficial breathing followed by the stop, weak heart sound, slow heart rate, ECG accelerated pacemaker ventricular arrhythmia immediately given positive pressure oxygen, artificial assisted breathing, intravenous injection of atropine and isoproterenol each 1mg, about 2 Resume spontaneous breathing after a minute, heart rate 110 beats / min, ECG shows sinus rhythm, left anterior branch block. 3 hours later, convulsions stopped, the mouth no longer overflow foam sputum, lungs did not smell and blisters sound, continue to give rehydration, sedation, care infection and symptomatic treatment. The next day the mind returned to normal, from the emergency room into the general ward. discuss