静脉输注利多卡因联合七氟醚对非体外循环冠状动脉旁路移植术患者的心肌保护作用  

Effects of lidocaine in combination with sevoflurane on myocardial protection in patients undergoing off-pump coronary artery bypass grafting

作　　者：刘扬[1] 吴安石[1] 吴迪[1] 杨丽娜[1] 崔伶俐[1] 岳云[1] 

机构地区：[1]首都医科大学北京朝阳医院麻醉科,100020

出　　处：《中华麻醉学杂志》2015年第2期149-153,共5页Chinese Journal of Anesthesiology

基　　金：首都医科大学北京朝阳医院青年科学基金（10QK29）

摘　　要：目的 评价静脉输注利多卡因联合七氟醚对非体外循环冠状动脉旁路移植术（OPCABG）患者的心肌保护作用.方法 择期行OPCABG患者100例,性别不限,年龄45 ～ 70岁,体重63 ～ 82 kg,NYHA分级Ⅰ或Ⅱ级,ASA分级Ⅱ或Ⅲ级,采用随机数字表法,将其分为4组（n=25）：对照组（C组）、利多卡因组（L组）、七氟醚组（S组）和七氟醚联合利多卡因组（SL组）.麻醉诱导气管插管后行机械通气,麻醉维持：4组静脉输注异丙酚3～8 mg· kg^-1·h^-1,维持脑电双频谱指数值45 ～ 55,间断静脉注射舒芬太尼0.5～ 1.0 μg/kg和哌库溴铵0.02～ 0.04 mg/kg.L组和SL组于气管插管后静脉注射利多卡因1.5 mg/kg,随后静脉输注利多卡因2 mg/min至术毕;S组和SL组于气管插管后吸入七氟醚（呼气末浓度2.2％～2.5％）至术毕.分别于麻醉诱导后手术前（基础状态）、切皮、离断乳内动脉后即刻、冠状动脉近端血管吻合完毕、术毕、术后24 h时采集静脉血样,检测血浆肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）和心肌肌钙蛋白Ⅰ（cTnI）的水平.记录术中以及术后24 h内心律失常、心动过缓或心脏停搏等利多卡因有关不良反应的发生情况.结果 与C组比较,其它3组血浆CK、CK-MB和cTnI的水平降低（P＜0.05或0.01）;与L组比较,SL组血浆CK-MB和cTnI的水平降低（P ＜0.05或0.01）;与S组比较,SL组血浆CK、CK-MB和cTnI的水平降低（P＜0.05）.L组和SL组无一例患者发生利多卡因有关的不良事件.结论 静脉输注利多卡因（气管插管后静脉注射1.5 mg/kg,随后以2 mg/min速率输注）联合七氟醚（呼气末浓度2.2％～2.5％）对OPCABG患者的心肌保护作用强于二者单独应用.Objective To evaluate the effects of lidocaine in combination with sevoflurane on myocardial protection in patients undergoing off-pump coronary artery bypass grafting （OPCABG）.Methods One hundred ASA physical status Ⅱ or Ⅲ and NYHA class Ⅰ or Ⅱ patients of both sexes,aged 45-70 yr,weighing 63-82 kg,scheduled for elective OPCABG,were randomly assigned into 4 groups （n=25 each）：control group （group C）,lidocaine group （group L）,sevoflurane group （group S）,sevoflurane combined with lidocaine group （group SL）.Tracheal intubation was performed after induction of anesthesia.Anesthesia was maintained with iv infusion of propofol and intermittent iv boluses of sufentanil and pipecuronium.Bispectral index value was maintained at 45-55.Lidocaine 1.5 mg/kg was injected after intubation,followed by infusion at 2 mg/min until the end of surgery in L and SL groups.Sevoflurane was inhaled with end-tidal concentration of 2.2%-2.5% starting from the end of intubation until the end of operation in S and SL groups.Before induction of anesthesia,at skin incision,immediately after transsection of internal mammary artery,after completion of anastomosis of the proximal aortovein and distal coronary artery,at the end of operation and at 24 h during operation,venous blood samples were obtained to detect the levels of plasma creatine kinase （CK）,creatine kinase isoenzyme-MB （CK-MB） and cardiac troponin Ⅰ （cTnI）.Lidocaine-related side effects such as arrhythmia,bradycardia or cardiac arrest were recorded during operation and within 24 h after operation.Results Compared with group C,the plasma CK,CK-MB and cTnI levels were decreased in the S,L and SL groups.The plasma CK-MB and cTnI levels were significantly lower in SL group than in L group.The plasma CK,CK-MB and cTnI levels were significantly lower in SL group than in S group.In L and SL groups,no patient developed lidocainerelated side effects.Conclusion Lidocaine 1.5 mg/kg injected intravenously after intubation,followed by infusion at 2

关 键 词：利多卡因 麻醉药 吸入 冠状动脉旁路移植术 非体外循环 心肌损伤 

分 类 号：R614[医药卫生—麻醉学]