小剂量利多卡因复合氯胺酮对老年胃肠道肿瘤患者术后早期认知功能的影响  

Effects of small-dose lidocaine combined with ketamine on early postoperative cognitive function in elderly patients undergoing gastrointestinal tumor surgery

作　　者：朱茗[1] 李元海[1] 万宗明[2] 张多志[2] 王溪银[2] 

机构地区：[1]安徽医科大学第一附属医院麻醉科,安徽合肥230022 [2]马鞍山市人民医院麻醉科,安徽马鞍山243000

出　　处：《南方医科大学学报》2015年第7期1076-1078,F0003,共4页Journal of Southern Medical University

基　　金：安徽省科技攻关计划项目(1301042204)

摘　　要：目的观察静脉注射小剂量利多卡因和氯胺酮进行麻醉干预对老年胃肠道肿瘤患者术后早期认知功能的影响。方法选择拟行择期手术的老年胃肠道肿瘤患者60例，年龄63～82岁，ASA分级Ⅰ-Ⅲ级。采用随机数字表法，将患者分为干预组（I组）和对照组（Ⅱ组），每组30例。静脉诱导气管插管后，Ⅰ组静注利多卡因和氯胺酮各0．5mg／kg，继以利多卡因0．5mg／（kg·h）持续输注直至术毕；Ⅱ组静注等容量的生理盐水。分别在术前3d和术后2d对患者进行神经心理学测试，计算术后成绩与术前基础值的差值（X值），记录术后认知功能障碍（POCD）的发生情况。分别于麻醉诱导前（T0）、术毕时（T1）、术后1天（T2）及术后2天（L）抽取外周静脉血，ELISA法分别检测S-100β蛋白、神经元特异性烯醇化酶（NSE）及IL-6浓度。结果X值比较，与Ⅱ组比较，Ⅰ组数字符号测试、累加测试及循迹连线测试A均显著降低（P〈0．05）。Ⅰ组和Ⅱ组POCD发生率分别为6．7％和33．3％，Ⅰ组显著低于Ⅱ组（P〈0．05）。T1时点，Ⅰ组S-10013蛋白、NSE及IL-6浓度均显著低于Ⅱ组（P〈O．05）；T2时点，Ⅰ组NSE及IL-6浓度均显著低于Ⅱ组（P〈0．05）；T3时点，Ⅰ组IL-6浓度显著低于Ⅱ组（P〈0．05）。结论术中静注小剂量利多卡因和氯胺酮进行麻醉干预可以降低老年胃肠道肿瘤患者术后早期认知功能障碍的发生率，可能与其降低血清S-100β蛋白、NSE及IL-6浓度有关。Objective To observe the effects of anesthetic intervention with small-dose lidocaine and ketamine on early postoperative cognitive function in elderly patients undergoing surgeries for gastrointestinal tumors. Methods Sixty patients （ASA Ⅰ-Ⅲ, aged 63-82 years） scheduled for surgeries for gastrointestinal tumors were randomized into intervention group （n= 30） and control group （n=30）. After intravenous induction and tracheal intubation, the patients in the interventional group received intravenous infusion of 0.5 mg/kg lidocaine and 0.5 mg/kg ketamine, followed by continuous infusion of lidocaine at the rate of 0.5 mg. kg^-1·h-1 till the end of the operation; the patients in the control group received saline infusion only. The cognitive function of the patients was assessed at 3 day before and 2 day after the operation using comprehensive neuro-psychological tests. Peripheral venous blood was extracted before anesthesia induction （To）, at the end of the surgery （T1）, and at 1 day （T2） and 2 days （T3） after the operation for measurement of serum S-100β protein, NSE and IL-6 levels using ELISA. Results The difference between the test scores before and after the operation （X values） was significantly smaller in the intervention group than in the control group （P〈0.05）. The intervention group showed a significantly lower incidence rate of postoperative cognitive dysfunction （POCD） than the control group （6.7% vs 33.3%, P〈0.05）. Compared with the control group, the intervention group exhibited significantly lower serum levels of S-100β protein, NSE and IL-6 at T1 （P〈0.05）, significantly lower NSE and IL-6 levels at T2 （P〈0.05） time point, and significantly lower IL-6 level at T3 （P〈0.05）. Conclusion Intravenous injection of small-dose lidocaine and ketamine during the operation can reduce the incidence of POCD in elderly patients undergoing surgeries for gastrointestinal tumors possibly in relation to decreased serum S-100β, NSE and IL-6 levels.

关 键 词：利多卡因 氯胺酮 老年 胃肠道肿瘤 术后认知功能障碍 S-100Β 神经元特异性烯醇化酶 白细胞介素6 

分 类 号：R614[医药卫生—麻醉学] R735[医药卫生—外科学]