静脉输注利多卡因用于肛肠手术对患者血流动力学、氧化应激及认知功能的影响  

Effects of intravenous infusion of lidocaine on hemodynamic,oxidative stress and cognitive 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 Zhjangjiakou 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5期754-757,共4页Hebei Medical Journal

基　　金：张家口市科技攻关计划项目(编号:1821153H)。

摘　　要：目的研究静脉输注利多卡因用于肛肠手术对患者血流动力学、氧化应激及认知功能的影响。方法复杂肛瘘患者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。监测2组麻醉前(T0)、麻醉后5 min(T1)、麻醉后10 min(T2)、麻醉后15 min(T3)、术毕5 min(T4)血流动力学[平均动脉压(MAP)、心率(HR)]。测定2组术前及术后24、72 h脑氧代谢指标[颈内静脉球部血氧饱和度(SjvO2),计算桡动脉-颈内静脉球部血氧差值(Da-jvO2)、脑氧摄取率(CEO2)]、氧化应激指标[丙二醛(MDA)、过氧化氢酶(CAT)、超氧化物歧化酶(SOD)]、神经元特异性烯醇化酶(NSE)、S-100β及简易智能精神状态检查量表(MMSE)评分。评估2组认知功能障碍(POCD)发生率。结果2组不同时间点MAP、HR比较差异无统计学意义(P>0.05)。C组不同时间点SjvO2、Da-jvO2、CEO2比较差异无统计学意义(P>0.05),L组术后24、72 h SjvO2均明显高于术前,Da-jvO2、CEO2均明显低于术前(P<0.05)。2组术前血清MDA、CAT、SOD、NSE、S-100β、MMSE评分比较差异无统计学意义(P>0.05),2组术后24、72 h血清MDA、NSE、S-100β均明显高于术前,CAT、SOD、MMSE评分均明显低于术前(P<0.05),但L组MDA、NSE、S-100β低于C组,CAT、SOD、MMSE评分高于C组(P<0.05)。L组术后24、72 h POCD发生率均明显低于C组(P<0.05)。结论静脉输注利多卡因用于肛肠手术能够维持血流动力学相对稳定,减轻氧化应激,并减少POCD发生。Objective To investigate the effects of intravenous infusion of lidocaine on hemodynamic,oxidative stress and cognitive function in patients undergoing anorectal surgery.Methods A total of 60 patients who underwent anorectal surgery in our hospital from January 2018 to January 2019 were enrolled in the study,who were randomly divided into two groups,with 30 cases in each group.The patients in control group(group C)were treated by saddle anesthesia.Before the induction of anesthesia,the patients in lidocaine group(group L)were given intravenous injection of lidocaine with 1.5mg/kg diluted to 10 ml saline,who were subsequently injected with the speed of 1.5mg·kg^-1·h^-1 till the end of surgery.After surgery the patients in both groups received patient-controlled intravenous analgesia with sufentanil.The changes of mean arterial pressure(MAP)and heart rate(HR)at different time points were recorded,moreover,the SjvO2,Da-jvO2,CEO2,MDA,CAT,SOD,NSE,S-100βand MMSE scores before operation and at 24h,72h after operation were observed and compared between the two groups.In addition the incidence rate of POCD were compared between the two groups.Results There were no significant differences in MAP and HR at different time points between the two groups(P>0.05).There were no significant differences in SjvO2,Da-jvO2 and CEO2 at different time points in group C(P>0.05).The SjvO2 levels at 24h and 72h after operation in group L were significantly higher than those before operation,however,the levels of Da-jvO2 and CEO2 were significantly lower than those before operation(P<0.05).Before operation,there were no significant differences in serum levels of MDA,CAT,SOD,NSE,S-100βand MMSE scores between the two groups(P>0.05).At 24h and 72h after operation,the serum levels of MDA,NSE and S-100βin both groups were significantly higher than those before operation,but,the CAT,SOD and MMSE scores were significantly lower than those before operation(P<0.05).Moreover the serum levels of MDA,NSE and S-100βin group L were significantly lo

关 键 词：肛肠手术 利多卡因 血流动力学 氧化应激 认知功能障碍 

分 类 号：R971.2[医药卫生—药品]