利多卡因对体外循环病人炎症反应的影响  

EFFECT OF LIDOCAINE ON SYSTEMIC INFLAMMATORY RESPONSE SYNDROME CAUSED BY CARDIOPULMONARY BYPASS

作　　者：黄强[1] 徐平[1] 袁莉[1] 李筱琴[1] 王世端[1] 曹倩[2] 

机构地区：[1]青岛大学医学院附属医院心血管外科,山东青岛266003 [2]青岛市妇女儿童医疗保健中心

出　　处：《青岛大学医学院学报》2008年第6期535-537,共3页Acta Academiae Medicinae Qingdao Universitatis

摘　　要：目的通过测定血浆中肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）及白细胞介素-8（IL-8）在体外循环（CPB）心内直视手术不同阶段的浓度变化,研究利多卡因对体外循环所致的机体炎症反应的影响。方法30例择期行瓣膜置换术的风湿性心脏病病人,随机分为对照组（A组）、大剂量抑肽酶组（B组）、利多卡因组（C组）。所有病人均应用静脉复合全身麻醉,常规建立体外循环,分别于麻醉后切皮前（T1）、主动脉阻断30 min（T2）、CPB结束时（T3）、CPB后2 h（T4）、CPB后24 h（T5）取桡动脉血6 mL,即刻离心,留取上清液,-72℃深低温保存,酶联免疫吸附反应（ELISA）法检测血浆中细胞因子TNF-α、IL-6、IL-8水平。结果3组TNF-α、IL-6、IL-8在CPB后即开始升高,至术后2 h达高峰,术后24 h降至正常水平。各组T3、T4时间点细胞因子浓度与其他时间点相比差异有显著性（F=81.91-183.99,q=3.18-30.39,P〈0.05）。B、C组T3、T4时间点各指标与对照组相比差异有显著性（F=13.60-149.10,q=5.31-23.67,P〈0.05）。而B组和C组相比差异无显著性（P〉0.05）。结论体外循环诱发全身炎症反应,导致炎性细胞因子的释放增加,利多卡因能减少细胞因子的释放,从而减轻CPB所致的机体炎症反应。Objective To investigate the effect of lidocaine on systemic inflammatory response syndrome （SIRS） caused by cardiopulmonary bypass （CPB）. Methods Thirty patients with rheumatic heart disease were randomly assigned to three groups （10 cases for each group） ： group A （control group）, Group B （aprotinin group） and Group C （lidocaine group）. The surgery was done under general balanced anesthesia and CPB was routinely set up. Six milliliter of radial artery blood was drawn on each of the five time point： T1 （before CPB）, T2 （30 rains after aortic clamping）, T3 （termination of CPB）, T4 （2 hours after CPB）, T5 （24 hours after CPB）. Blood samples were centrifuged promptly and the supernatant was stored at -72℃. The serum levels of TNF-α, IL-6 and IL-8 were determined by ELISA within three months. Results The serum levels of TNF-α, IL 6, and IL-8 were increased from the beginning of CPB, reached peak levels two hours after CPB, and dropped to normal 24 hours after CPB. The concentrations of TNF-α, IL-6 and IL-8 at T3 and T4 were significantly different from the other time points （F=81.91- 183.99,q=3.18-30.39,P〈0.05）. The cytokine levels on Ta and T4 in groups B and C were significantly different from those of group A （F=13.60-149. 10,q=5.31-23.67,P〈0.05）. There was no significant difference between groups B and C （P〉 0.05）. Conclusion CPB induces the release of cytokines, thereafter causes systemic inflammatory response syndrome. Lidocaine can decrease the levels of proinflammatory cytokines in plasma and therefore attenuate the systemic inflammatory response caused by CPB.

关 键 词：利多卡因 体外循环 炎症 细胞因子类 

分 类 号：R614[医药卫生—麻醉学]