利多卡因静脉持续输注对60岁以上患者胃肠道手术围术期心肌损伤标志物的影响  

Impact of lidocaine intravenous infusion on myocardial injury markers during gastrointestinal surgery in patients aged over 60 years old

作　　者：王海滨[1] 俞颖[2] 李浪平[2] 罗艳[3] 沈亮[2] 

机构地区：[1]上海交通大学医学院附属瑞金医院北院麻醉科,上海201800 [2]上海交通大学医学院附属瑞金医院卢湾分院麻醉科 [3]上海交通大学医学院附属瑞金医院麻醉科

出　　处：《上海医学》2017年第5期302-306,共5页Shanghai Medical Journal

基　　金：上海市卫生和计划生育委员会科研项目资助(201540315)

摘　　要：目的探讨利多卡因静脉持续输注对60岁以上患者胃肠道手术围术期心肌损伤标志物的影响。方法选择行择期胃肠道手术的患者80例,年龄均>60岁,随机分为利多卡因组和对照组,每组40例,分别在麻醉诱导前经静脉泵注射利多卡因或0.9%氯化钠溶液1.5mg/(kg·h)。术中监测患者的心率、血压,记录术中心血管不良反应发生情况。所有患者均于术前、术后即刻、术后24和48h检测心肌肌红蛋白(Myo)和N-末端脑钠素前体(NT-proBNP)水平。术中根据失液量或失血量补充相应的晶体、胶体或血制品,并记录总量。记录患者的ICU停留时间、住院天数等。结果两组患者的性别构成、年龄、BMI、射血分数、麻醉时间、手术时间、术中补液种类和补液量,以及术后ICU停留天数和住院天数的差异均无统计学意义(P值均>0.05)。利多卡因组的低血压、高血压、心动过缓、心动过速的发生率均显著低于对照组(P值均<0.05)。与同组术前比较,两组术后即刻和术后24h的Myo和NT-proBNP水平均显著升高(P值均<0.01)。利多卡因组术后即刻和术后24h的Myo和NT-proBNP水平均显著低于对照组同时间(P值均<0.01)。结论术中持续输注利多卡因1.5mg/(kg·h)可以降低60岁以上患者在胃肠道手术围术期心肌损伤标志物水平。Objective To investigate the effect of continuous intravenous infusion of lidocaine on the myocardical injury markers during gastrointestinal surgery in patients aged over 60 years old. Methods Eighty patients （;60 years old） scheduled for gastrointestinal surgery were randomly lidocaine group and control group （n =40）. Lidocaine and normal saline 1.5 mg/（kg ; h） were given via venous pump before anesthesia induction, respectively. Heart rate and blood pressure were monitored during surgery. The incidence of cardiovascular adverse reactions was recorded. Serum concentrations of myoglobin （Myo） and N-terminal pro-brain natriuretic peptide （NT-proBNP） were measured before surgery and immediately, 24 and 48 hours after surgery. The crystals, colloids and blood products were supplemented if necessary and the total amounts were recorded. Intensive Care Unit （ICU） stay and hospital stay were also recorded. Results There were no significant differences in sex composition, age, body mass index （BMI）, ejection fraction, anesthesia time, surgery time, intraoperative rehydration type and fluid volume, ICU stay or postoperative hospital stay between groups （all P〈 0.05）. The incidences of hypotension, hypertension, bradycardia and tachycardia in the lidocaine group were significantly lower than those in the control group （all P 〈 0. 05）. Compared with preoperative ones, the concentrations of Myo and NT-proBNP in both groups were significantly increased immediately and 24 hours after surgery. Moreover, the concentrations of Myo and NT-proBNP in the lidocaine group were significantly lower than those in the control group immediately and 24 hours after surgery （all P 〈 0. 01 ）. Conclusion Lidocaine continuous infusion 1.5 mg/（kg · h） can reduce the levels of myocardical injury markers during gastrointestinal surgery in patients aged over 60 years old.

关 键 词：利多卡因 肌红蛋白 N-末端脑钠素前体 胃肠道手术 

分 类 号：R614[医药卫生—麻醉学]