利多卡因对老年脊柱手术患者术后炎症免疫反应及认知功能的影响  

Effect of lidocaine on the postoperative inflammatory factors and cognitive dysfunction for elderly patients undergoing spinal operation

作　　者：王红运[1] 高臻辉[1] 梁斌[1] 宁俊平 

机构地区：[1]宝鸡市中心医院麻醉科,陕西宝鸡721008 [2]西电集团医院麻醉科,陕西西安710077

出　　处：《药物评价研究》2017年第7期979-982,共4页Drug Evaluation Research

摘　　要：目的探讨静脉输注利多卡因对行脊柱手术的老年患者术后炎症免疫反应及认知功能的影响。方法选择2015年1月—2016年1月在宝鸡市中心医院行脊柱手术的老年患者80例,随机分为两组,每组40例,对照组患者接受常规全麻,实验组患者在对照组基础上静脉输注利多卡因负荷量1 mg/kg,维持量为1.5 mg/kg直至手术结束。比较两组患者术前术后的MMSE评分以及术后认知功能障碍(POCD)的发生情况,检测两组患者术前术后免疫炎症因子的表达水平并对其进行统计学分析。结果实验组患者术后3 d的MMSE评分显著低于对照组,差异有统计学意义(P<0.05);实验组POCD的发生率显著低于对照组,差异有统计学意义(P<0.05)。实验组患者术后7 d血清中Ig A、Ig M以及Ig G的水平显著高于对照组,差异有统计学意义(P<0.05);在术后3 d及术后7 d,实验组患者血清白介素-6(IL-6)水平显著低于对照组,差异有统计学意义(P<0.05),但是两组患者血清中肿瘤生长因子-α(TNF-α)的水平相当,差异无统计学意义。结论老年患者行脊柱手术时,术中静脉输注利多卡因,可以有效抑制炎症反应的发生,改善患者的免疫功能,降低患者术后发生POCD的发生率,值得临床推荐应用。Objective To explore the effect of lidocaine with intravenous infusion on the postoperative inflammatory factors and cognitive dysfunction for elderly patients undergoing spinal operation. Method 80 elderly patients undergoing spinal operation in Central hospital of Baoji were enrolled from January 2015 to January 2016, of which patients divided into two groups randomly, control group （n = 40） accepted routine general anesthesia, and study group （n = 40） adopted intravenous lidocaine based on the patients in control group, comparing the MMSE score and the incidence of postoperative cognitive dysfunction （POCD） with before operation, detecting and analyzing the difference of inflammatory and immunity factors. Results The MMSE score of the study group after three days of operation was significantly lower than that of the control group, the difference was statistically significant （P 〈 0.05）. The incidence of POCD in the study group was significantly lower than that in the control group, the difference was statistically significant （P 〈 0.05）. The serum levels of IgA, IgM and IgG in the study group after seven days of operation were significantly higher than those in the control group, the difference was statistically significant （P 〈 0.05）. After three days and seven days postoperatively, the serum levels of interleukin -6 （IL-6） in the study group were significantly lower than those in the control group, the difference was statistically significant （P 〈 0.05）. And there was no significance of TNF-ct between two groups at any time point. Conclusions Intravenous lidocaine for patients undergoing spinal operation could inhibit the inflammatory response, improve the function of immunity, and decrease the incidence of POCD, which deserved popularization in clinic.

关 键 词：老年脊柱手术 利多卡因 免疫功能 炎症因子 术后认知功能 

分 类 号：R969.4[医药卫生—药理学]