利多卡因联合参附注射液对体外循环致全身炎性反应的影响  

Lidocaine combined with Shenfu injection alleviates systemic inflammatory response to cardiopulmonary bypass

作　　者：张义轩[1] 马传根[1] 赵景霞[1] 王勇[1] 王丽萍[1] 郭素莲[1] 

机构地区：[1]河南大学麻醉与危重病医学研究所,河南大学淮河医院麻醉科,开封475000

出　　处：《上海医学》2008年第3期165-168,共4页Shanghai Medical Journal

摘　　要：目的探讨利多卡因联合参附注射液对体外循环(CPB)致全身炎性反应的影响。方法择期CPB患者40例,男26例,女14例,体重60～80 kg,年龄45～65岁,美国麻醉医师协会(ASA)分级Ⅱ或Ⅲ级,随机均分为对照组(A组)、利多卡因组(B组)、参附注射液组(C组)和利多卡因联合参附注射液组(D组)。B、C、D组分别在切开心包时持续静脉泵注利多卡因4 mg/min、参附注射液1 mL/kg及两者联合静脉泵注至术毕。B、D组在CPB预充液中另加入利多卡因4 mg/kg,C、D组在CPB预充液中另加入参附注射液1 mL/kg。A组以同样速率输入等量0.9%氯化钠溶液。B、D组均随机选取5例患者,分别于CPB开始后10、60 min和术毕时抽取桡动脉血,采用气相色谱法测定血浆利多卡因质量浓度。分别于CPB前切心包时(T_0)及主动脉开放心脏复跳后1 min(T_1)、10 min(T_2)、60 min(T_3)抽取桡动脉血。测定血浆肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6的质量浓度,并进行中性粒细胞(PMN)计数。结果B、D组CPB开始后10、60 min和术毕时血浆利多卡因质量浓度的差异均无统计学意义(P值均>0.05)。与T_0时间点比较,4组T_1、T_2、T_3时间点血浆TNF-α、IL-6浓度及PMN计数均显著升高(P值均<0.01)。与A组T_1、T_2、T_3时间点比较,B、C、D组相应时间点血浆TNF-α、IL-6浓度和PMN计数显著降低(P值均<0.01);与B、C组T_1、T_2、T_3时间点比较,D组血浆TNF-α、IL-6浓度和PMN计数显著降低(P值均<0.05)。结论利多卡因联合参附注射液能明显减轻CPB所致全身炎性反应。Objective To evaluate the effects of lidocaine combined with Shenfu injection on systemic inflammatory response to cardiopulmonary bypass （CPB）. Methods Forty ASA class Ⅱ or Ⅲ patients aged 45- 65 years weighing 60-80 kg （consisting of 26 male and 14 female patients） were randomly assigned into 4 equal groups, namely the control group （A）, lidocaine group （B）, Shenfu injection group （C）, and lidoeaine plus Shenfu injection group （D）. In the latter 3 groups, intravenous lidocaine infusion at 4 mg/min via an intravenous pump, intravenous infusion of Shenfu injection （1 mL/kg）, and their combination, respectively, was given at the time of pericardium incision and maintained till the end of the surgery. In groups B and D, lidocaine （4 mg/kg） were added into the priming solution, and in groups C and D Shenfu injection （1 mL/kg） was added instead. The patients in the control group received only an equivalent volume of normal saline infused at the same rate. From groups B and D, 5 patients were selected at random and radial artery blood samples were taken at 10 and 60 rain after CPB initiation and at the end of surgery to determine the plasma lidocaine concentration using gas chromatography. In all the patients, radial artery blood samples were collected before CPB （T0） and at 1, 10 and 60 min after release of the aortic cross-clamp （T1 , T2 , Ta , respectively） for determination of plasma concentration of tumor necrosis factor-α （TNF-α）, interleukiw6 （IL-6） and polymorphonuclear leucocyte （PMN） count. Results The mean plasma lidocaine concentration was （4.0±0.6）, （4.5 ± 0.8） and （5.9± 0.9） mg/L at 10,60 min of CPB and at the end of surgery in the 10 patients from groups B and D, showing no significant difference between the time points （P〉0.05）. The plasma concentrations of TNF-α, IL-6 and PMN count all increased significantly at T1, T1,T2, and T3 as compared to the baseline levels at To （P〈0.01） in the 4 groups. At the time point

关 键 词：利多卡因 参附注射液 心肺转流术 炎症 

分 类 号：R654.1[医药卫生—外科学]