利多卡因对冠状动脉搭桥术患者体外循环致全身炎性反应的影响  

Influence of lidocaine on systemic inflammatory response to cardiopulmonary bypass in patients undergoing coronary artery bypass grafting

作　　者：王红梅[1] 戴安卢[1] 周海燕[1] 

机构地区：[1]浙江大学医学院附属第二医院麻醉科,杭州310009

出　　处：《中华麻醉学杂志》2006年第4期342-344,共3页Chinese Journal of Anesthesiology

摘　　要：目的探讨利多卡因对冠状动脉搭桥术患者体外循环(CPB)致全身炎性反应的影响。方法择期CPB下行冠状动脉搭桥术患者20例,男13例,女7例,年龄47-67岁,体重62-82 kg, ASAⅡ或Ⅲ级,随机分为对照组(C组)和利多卡因组(L组),每组10例。L组在切开心包时开始持续静脉泵注利多卡因4 mg/min至术毕,CPB预充液中另加入利多卡因4 mg/kg,C组以同样速率输入等量生理盐水。L组随机选取5例患者,分别于CPB开始后10、60 min和术毕取桡动脉血,用气相色谱法测定血浆利多卡因浓度。分别于CPB前切开心包时(T0)、主动脉开放心脏复跳后1 min(T1)、10 min (T2)、60min(T3)抽取桡动脉血,测定血浆肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)和白细胞介素- 10(IL-10)浓度,并进行中性粒细胞(PMN)计数。结果 L组CPB开始后10、60 min、术毕时血浆利多卡因浓度分别是4．1±0．5、4．6±0．7、(5．9±0．9)μg/ml。CPB可引起血浆TNF-α、IL-6、IL-10浓度及PMN 计数升高,利多卡因可减轻CPB所致全身炎性反应。结论利多卡因可减轻冠状动脉搭桥术患者 CPB致全身炎症反应。Objective To investigate the influence of lidocaine on systemic inflammatory response to cardiopulmonary bypass （CPB） in patients undergoing coronary artery bypass grafting （CABG）. Methods Twenty ASA Ⅱ or Ⅲ patients of both sexes （13 males, 7 females） aged 47-67 yrs weighing 62-82 kg undergoing CABG were randomly divided into 2 groups of 10 each： control group （C） and lidocaine group （L）. In group L lidocaine infusion was started as soon as the pericardium was cut open and maintained at 4 mg · min^- 1 until the end of the surgery. Another dose of lidocaine （4 mg· kg^-1 ） was added to the prime. In control group normal saline （NS） was given instead of lidocaine in the same volume and at the same speed. Blood samples were taken from radial artery before CPB （T0, baseline） and at 1, 10 and 60 min after release of the aortic cross-clamp （T1. 2.3 ） for determination of plasma concentration of TNF-α, IL-6, IL-10 and PMN count. Plasma lidocaine concentration was determined at 10 and 60 min after initiation of CPB and at the end of surgery in 5 patients in group L. Results The two groups were comparable with respect to age, sex ratio （M/F）, body weight, CPB time and aortic cross- clamping time. The mean plasma lidocaine concentration was （ 4.1 ± 0. 5 ） μg·ml^- 1 , （4.6 ± 0. 7 ） μg·ml^- 1 and （5.9 ＋ 0.9） μg· ml ^- 1 at 10, 60 min of CPB and end of surgery respectively in group L. Plasma concentrations of TNF-α, IL-6, IL-10 and PMN count were significantly increased at T1. 2.3 as compared to the baseline values at To in both groups. The plasma concentrations of TNF-α and IL-6 were significantly lower while those of IL-10 were significantly higher at T1-3 in group L than in group C. Conclusion Lidocaine can inhibit the inflammatory response induced by CPB in patients undergoing CABG.

关 键 词：利多卡因 心肺转流术 冠状动脉分流术 炎症 

分 类 号：R614[医药卫生—麻醉学]