静脉输注利多卡因用于肛肠手术对患者疼痛介质、炎性应激反应及免疫功能的影响  

Effects of intravenous infusion of lidocaine on pain media,inflammatory stress response and immune function in patients undergoing anorectal surgery

作　　者：赵馨 高洁[5] 张艳丽[5] 杨涛 李辉 刘进中 韩建民[6] ZHAO Xin;GAO Jie;ZHANG Yanli(Department of Anesthesia,The Fifth Hospital of Zhangjiakou City, Hebei,Zhangjiakou 075000,China)

机构地区：[1]河北省张家口市第五医院麻醉科,075000 [2]河北省张家口市第五医院肛肠二科,075000 [3]河北省张家口市第五医院手术室,075000 [4]河北省张家口市第五医院外科,075000 [5]中国人民解放军陆军第八十一集团军医院麻醉科 [6]河北医科大学第二医院麻醉科

出　　处：《河北医药》2020年第3期416-419,共4页Hebei Medical Journal

基　　金：张家口市科学技术研究与发展攻关计划项目(编号:1821153H)

摘　　要：目的观察静脉输注利多卡因用于肛肠手术对患者疼痛介质、炎性应激反应及免疫功能的影响。方法选取2018年1月至2019年1月接受治疗的复杂肛瘘患者60例,随机分为对照组(C组)、利多卡因组(L组),每组30例。C组采用鞍麻。L组于麻醉诱导前静脉输注利多卡因1.5 mg/kg,稀释到10 ml 0.9%氯化钠溶液中,随后以1.5 mg·kg-1·h-1的速度持续输注至手术结束。术后2组均使用舒芬太尼自控静脉镇痛。比较2组术前、术后24 h血清疼痛介质[P物质(SP)、神经肽Y(NPY)、内啡肽(β-EP)]、应激激素[去甲肾上腺素(NE)、皮质醇(Cor)、C肽(CP)]、炎性因子[白介素1β(IL-1β)、白介素6(IL-6)、肿瘤坏死因子α(TNF-α)]及外周血T淋巴细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+)、免疫球蛋白(IgA、IgG、IgM)变化。结果2组不同时间点MAP、HR比较差异无统计学意义(P>0.05)。2组术前血清SP、NPY、β-EP、NE、Cor、CP、IL-1β、IL-6、TNF-α、外周血CD3+、CD4+、CD8+、CD4+/CD8+、IgA、IgG、IgM比较差异无统计学意义(P>0.05),2组术后24 h血清SP、NPY、β-EP、NE、Cor、CP、IL-1β、IL-6、TNF-α、外周血CD8+均明显高于术前,外周血CD3+、CD4+、CD4+/CD8+、IgA、IgG、IgM均明显低于术前(P<0.05),但L组血清SP、NPY、β-EP、NE、Cor、CP、IL-1β、IL-6、TNF-α、外周血CD8+低于C组,外周血CD3+、CD4+、CD4+/CD8+、IgA、IgG、IgM高于C组(P<0.05)。结论静脉输注利多卡因用于肛肠手术能够显著抑制疼痛介质分泌,减轻炎性应激反应,并提高免疫功能。Objective To investigate the effects of intravenous infusion of lidocaine on pain media,inflammatory stress response and immune function in patients undergoing anorectal surgery.Methods A total of 60 patients with complex anal fistula who underwent anorectal surgery in our hospital from January 2018 to January 2019 were randomly divided into control group(group C)and lidocaine group(group L),with 30 cases in each group.The patients in control group were treated by saddle anesthesia.Before the anesthesia indaction,the patients in group L were treated by intravenous injection of lidocaine,with 1.5mg/kg being diluted to 10 ml saline,then were subsequently injected at the speed of 1.5mg·kg-1·h-1 till the end of surgery.The patients in both groups received patient-controlled intravenous analgesia of sufentanil after surgery.The serum levels of pain media(SP,NPY andβ-EP),stress hormones(NE,Cor and CP),inflammatory cytokines(IL-1β,IL-6 and TNF-α)and peripheral T lymphocyte subsets(CD3+,CD4+,CD8+and CD4+/CD8+)and immunoglobulin(IgA,IgG and IgM)before operation and 24 h after operation were observed and compared between two groups.Results There were no significant differences in MAP and HR between the two groups at different time points(P>0.05).Before operation,there were no significant differences in the serum levels of SP,NPY,β-EP,NE,Cor,CP,IL-1β,IL-6,TNF-α,IgA,IgG and IgM between the two groups(P>0.05).At 24h after operation,the serum levels of SP,NPY,β-EP,NE,Cor,CP,IL-1β,IL-6,TNF-αand peripheral CD8+were significantly increased in both groups,as compared with those before operation,however,the levels of peripheral CD3+,CD4+,CD4+/CD8+,IgA,IgG and IgM were significantly decreased in both groups(P<0.05).However,the serum levels of SP,NPY,β-EP,NE,Cor,CP,IL-1β,IL-6,TNF-αand peripheral CD8+of in group L were significantly lower than those in group C,and the levels of peripheral CD3+,CD4+,CD4+/CD8+,IgA,IgG and IgM in group L were significantly higher than those in group C(P<0.05).Conclusion The intravenous infu

关 键 词：肛肠手术 利多卡因 疼痛介质 炎性应激反应 免疫功能 

分 类 号：R971.2[医药卫生—药品]