Lidocaine, tseem hu ua lignocaine, yog siv dav siv tshuaj loog hauv zos thiab tus neeg sawv cev tiv thaiv arrhythmic. Ua ntej sib xyaw ua ke hauv 1943 los ntawm Swedish chemist Nils Löfgren, lidocaine tau dhau los ua lub hauv paus hauv ob qho tib si phais thiab tshuaj kho mob xwm txheej ceev vim nws qhov pib sai, lub sijhawm nruab nrab ntawm kev ua haujlwm, thiab cov ntaub ntawv muaj txiaj ntsig zoo. Kab lus no muab cov ncauj lus kom ntxaws txog lidocaine's pharmacology, kev siv tshuaj kho mob, kev txiav txim siab txog kev nyab xeeb, thiab kev nce qib tsis ntev los no hauv nws txoj kev siv.
Kev Lag Luam
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Pharmacology ntawm Lidocaine
► Chemical Structure thiab Properties
Lidocaine belongs rau cov chav kawm amide ntawm cov tshuaj loog hauv zos, uas yog lub nplhaib uas muaj ntxhiab txuas nrog cov amino pawg ntawm kev sib txuas ntawm amide. Nws cov qauv tshuaj yog C₁₄H₂₂N₂O, thiab nws zoo ib yam li lwm yam tshuaj loog zoo li bupivacaine thiab mepivacaine. Lidocaine yog dawb crystalline hmoov soluble nyob rau hauv dej thiab cov kuab tshuaj organic, ua rau nws haum rau ntau yam formulations, xws li txhaj tshuaj, tshuaj pleev ib ce, gels, thiab thaj ua rau thaj.
► Mechanism of Action
Lidocaine siv nws cov tshuaj loog los ntawm kev thaiv qhov hluav taws xob -gated sodium channels (VGSCs) ntawm cov paj hlwb. Cov channel no yog qhov tseem ceeb rau kev pib thiab nthuav tawm ntawm qhov ua tau zoo hauv cov paj hlwb. Los ntawm kev khi rau hauv qhov chaw ntawm lub cev ntawm sodium channel, lidocaine stabilizes daim nyias nyias hauv nws lub xeev tsis muaj zog, tiv thaiv sodium influx thiab yog li inhibiting paj hlwb impulse. Qhov kev thaiv no yog thim rov qab, tso cai rau cov paj hlwb ib txwm rov ua haujlwm dua thaum cov tshuaj metabolized thiab tshem tawm.
Cov nyhuv antiarrhythmic ntawm lidocaine kuj tau kho los ntawm VGSC blockade, tab sis nyob rau hauv cov ntsiab lus no, nws feem ntau cuam tshuam rau lub plawv myocytes. Los ntawm inhibiting sodium channels nyob rau hauv lub plawv, lidocaine txo cov excitability ntawm lub plawv cov ntaub so ntswg, suppressing txawv txawv hluav taws xob kev ua si xws li ventricular tachycardia thiab ventricular fibrillation.
Kev siv tshuaj kho mob ntawm Lidocaine
Local tshuaj loog
Lidocaine yog ib qho ntawm feem ntau siv tshuaj loog hauv zos hauv kev kho mob. Nws versatility tso cai rau siv nyob rau hauv ntau yam txheej txheem, xws li:
Cov txheej txheem kho hniav: Lidocaine nquag siv rau infiltrative anesthesia hauv kev phais hniav, feem ntau ua ke nrog epinephrine kom ntev nws lub sij hawm thiab txo los ntshav.
Cov txheej txheem phais me me: Lidocaine yog siv rau hauv daim tawv nqaij infiltration, paj hlwb, thiab txha caj qaum (ua ke nrog lwm tus neeg ua haujlwm).
Obstetrics: Lidocaine yog siv rau cov tshuaj loog epidural thaum lub sij hawm ua hauj lwm thiab kev yug me nyuam, muab qhov mob zoo nrog rau cov me nyuam hauv plab me me.
Ophthalmology: Lidocaine is applied topically to the eye to anesthetize the cornea and conjunctiva for procedures like tonometry and foreign body removal.
Antiarrhythmic Therapy
Lidocaine yog qhia rau kev tswj mob hnyav ntawm ventricular arrhythmias, tshwj xeeb tshaj yog nyob rau hauv qhov chaw ntawm mob myocardial infarction (AMI) lossis kev phais plawv. Nws muaj txiaj ntsig zoo hauv kev tiv thaiv ventricular premature contractions (VPCs), ventricular tachycardia (VT), thiab ventricular fibrillation (VF). Txawm li cas los xij, nws txoj kev siv tau poob qis hauv xyoo tas los no nrog rau qhov tshwm sim ntawm cov tshuaj tiv thaiv kev mob ntshav qab zib tshiab zoo li amiodarone, uas muaj cov txiaj ntsig dav dua thiab cov kev mob tshwm sim tsawg dua.
Neuropathic Pain Management
Cov tshuaj pleev xim lidocaine, xws li cream, gels, thiab thaj ua rau thaj, yog siv los tswj cov mob neuropathic hauv zos, suav nrog:
Postherpetic neuralgia (PHN): Lidocaine thaj ua rau thaj yog FDA- pom zoo rau kev kho mob ntawm PHN, muab cov hom phiaj kho mob nrog kev nqus tsawg kawg nkaus.
Mob ntshav qab zib neuropathy: Cov tshuaj lidocaine tuaj yeem pab txo qhov mob cuam tshuam nrog ntshav qab zib peripheral neuropathy.
Lwm yam mob neuropathic: Lidocaine yuav raug siv tawm ntawm - daim ntawv lo rau tej yam mob xws li complex regional pain syndrome (CRPS) thiab trigeminal neuralgia.
Lwm yam kev siv
Intravenous regional anesthesia (Bier block): Lidocaine yog siv rau cov tshuaj loog ntawm cov extremities thaum lub sij hawm luv luv phais cov txheej txheem.
Tonsillectomy mob: Tshuaj pleev xim lidocaine los yog lozenges tuaj yeem pab txo qhov mob tom qab -tonsillectomy.
Esophageal intubation: Lidocaine jelly yog siv los lubricate thiab anesthetize txoj hlab pas thaum cov txheej txheem endoscopic.
Contraindications thiab ceev faj
Lidocaine yog contraindicated nyob rau hauv cov neeg mob uas muaj ib tug paub hypersensitivity rau amide - hom tshuaj loog nyob rau hauv lub zos tshuaj loog los yog ib feem ntawm cov formulation. Kev ceev faj yuav tsum tau ua hauv:
Cov neeg mob uas muaj kab mob siab: Txo cov lidocaine metabolism ua rau muaj kev pheej hmoo ntawm toxicity.
Cov neeg mob uas muaj lub plawv tsis ua haujlwm lossis mob plawv tsis ua haujlwm: Lidocaine tuaj yeem ua rau muaj qhov txawv txav.
Cov poj niam cev xeeb tub thiab pub niam mis: Thaum lidocaine feem ntau suav hais tias muaj kev nyab xeeb thaum cev xeeb tub, nws yuav tsum tau siv ceev faj, thiab cov niam pub niam mis yuav tsum tsis txhob siv tshuaj pleev rau ntawm lub mis.
Cov neeg laus: Txo lub raum thiab lub siab ua haujlwm tuaj yeem ncua kev tshem tawm ib nrab- lub neej, yuav tsum tau hloov tshuaj.
Cov kev nce qib tsis ntev los no thiab cov kev taw qhia yav tom ntej
Novel Formulations
Cov kws tshawb fawb txuas ntxiv tshawb nrhiav cov qauv tshiab ntawm lidocaine los txhim kho nws cov txiaj ntsig thiab kev nyab xeeb. Piv txwv li:
Liposomal lidocaine: Encapsulating lidocaine nyob rau hauv liposomes prolongs nws lub sij hawm ntawm kev txiav txim thiab txo lub cev nqus dej, ua rau nws zoo tagnrho rau kev kho mob tshuaj pleev ib ce.
Nanosized lidocaine: Nanoparticle formulations tuaj yeem txhim kho kev nkag mus thiab khaws cia ntawm lidocaine hauv cov ntaub so ntswg, txhim kho nws cov tshuaj loog.
Kev sib xyaw ua ke: Kev sib xyaw lidocaine nrog lwm cov tshuaj tua kab mob lossis cov tshuaj ntxiv (xws li corticosteroids, clonidine) tuaj yeem txhim kho nws qhov mob - txo cov khoom thiab txo cov koob tshuaj uas xav tau.
Alternative Delivery Systems
Transdermal thaj ua rau thaj: Lidocaine thaj ua rau thaj twb tau siv dav rau kev mob neuropathic, tab sis cov thaj ua rau thaj tshiab tshiab nrog cov khoom nplaum zoo dua qub thiab tswj tau -tso tawm mechanisms raug tsim.
Microneedle arrays: Microneedle thev naus laus zis tso cai rau qhov tsis muaj mob thiab raug xa tawm ntawm lidocaine rau hauv daim tawv nqaij, muab lwm txoj hauv kev rau kev txhaj tshuaj ib txwm muaj.
Iontophoresis: Cov txheej txheem no siv cov hluav taws xob tam sim no los tsav lidocaine ions rau hauv daim tawv nqaij, muab cov tshuaj loog uas tsis yog - ntxeem tau hauv zos.
Expanding Clinical Indications
Thaum lidocaine cov kev siv tseem ceeb tseem nyob hauv cov tshuaj loog hauv zos thiab kev kho mob antiarrhythmic, kev tshawb fawb tsis tu ncua tab tom tshawb nrhiav nws lub peev xwm hauv lwm qhov chaw, xws li:
Kev tswj mob qog noj ntshav: Lidocaine lub peev xwm los thaiv cov sodium channel tuaj yeem ua rau nws muaj txiaj ntsig zoo hauv kev kho qee yam mob qog noj ntshav- mob ntsig txog.
Migraine prophylaxis : Qee cov kev tshawb fawb qhia tias lidocaine tuaj yeem pab txo qhov zaus thiab qhov hnyav ntawm migraines thaum siv tshuaj intravenously lossis los ntawm qhov ntswg.
Cov mob mob ntev: Lidocaine lub luag haujlwm hauv kev tswj cov mob ntev xws li fibromyalgia thiab mob qis qis yog raug tshawb xyuas.
Xaus
Lidocaine yog ib qho tshuaj muaj ntau yam thiab siv dav siv nrog rau qhov zoo -tsim muaj kev nyab xeeb profile thiab ntau yam kev siv tshuaj kho mob. Nws lub peev xwm los muab tshuaj loog zoo hauv zos thiab tswj ventricular arrhythmias tau ua rau nws yog ib qho cuab yeej tseem ceeb hauv cov tshuaj niaj hnub. Kev tshawb fawb tsis tu ncua rau hauv cov qauv tsim tshiab, lwm lub tshuab xa khoom, thiab nthuav cov ntaub ntawv kho mob txuas ntxiv txhim kho nws cov txiaj ntsig thiab txhim kho cov txiaj ntsig ntawm tus neeg mob. Txawm li cas los xij, cov kws kho mob yuav tsum tau ceev faj txog qhov muaj peev xwm rau toxicity, tshwj xeeb tshaj yog nyob rau hauv cov neeg tsis muaj zog, thiab ua raws li cov lus pom zoo kom noj tshuaj kom zoo thiab siv tau zoo. Raws li peb txoj kev nkag siab ntawm lidocaine's pharmacology thiab kev kho muaj peev xwm hloov zuj zus mus, nws zoo li yuav nyob twj ywm lub hauv paus ntawm kev tswj qhov mob thiab kev siv tshuaj loog rau xyoo tom ntej.