利多卡因雾化吸入对单肺通气患者围术期肺功能、炎症因子及相关并发症的影响  

Effects of Lidocaine Aerosol Inhalation on Perioperative Pulmonary Function,Inflammatory Factors and Related Complication of Patients with One-lung Ventilation

作　　者：陶广华 吴勇[2] 葛华顺 于布为[4] TAO Guanghua;WU Yong;GE Huashun;YU Buwei(Dept.of Anesthesiology,Xichang People’s Hospital,Sichuan Xichang 615000,China;Dept.of Anesthesiology,Panzhihua Central Hospital,Sichuan Panzhihua 617002,China;Dept.of Anesthesiology,the Affiliated Hospital of Panzhihua University,Sichuan Panzhihua 617000,China;Dept.of Anesthesiology,Ruijin Hospital Affiliated to Shanghai Jiaotong University School,Shanghai 200020,China)

机构地区：[1]西昌市人民医院麻醉科,四川西昌615000 [2]攀枝花市中心医院麻醉科,四川攀枝花617002 [3]攀枝花学院附属医院麻醉科,四川攀枝花617000 [4]上海交通大学附属瑞金医院麻醉科,上海200020

出　　处：《中国药房》2021年第18期2254-2259,共6页China Pharmacy

基　　金：四川省教育厅科研项目(No.18ZB0344)。

摘　　要：目的:探讨利多卡因雾化吸入对单肺通气患者围术期肺功能、炎症因子及相关并发症的影响。方法:将2018年1月-2020年5月攀枝花学院附属医院收治的拟择期于全身麻醉单肺通气下行肺部分切除术的120例患者按随机数字表法分为利多卡因雾化吸入组(L组)和无菌水雾化吸入组(N组),每组60例。两组患者均以静脉注射咪达唑仑注射液0.1 mg/kg+丙泊酚乳状注射液2.0 mg/kg+枸橼酸舒芬太尼注射液0.4μg/kg行麻醉诱导;于插入双管气管插管后,L组患者雾化吸入盐酸利多卡因注射液1.5 mg/kg加无菌水稀释至20 m L,N组患者雾化吸入无菌水20 m L,吸入流量均为2 L/min。两组患者均静脉持续泵注丙泊酚乳状注射液4~12 mg/(kg·h)+注射用盐酸瑞芬太尼0.2~1μg/(kg·min)+注射用苯磺顺阿曲库铵0.05~0.1 mg/(kg·h)行麻醉维持。术后8 h,L组患者再次雾化吸入盐酸利多卡因注射液1.5 mg/kg加无菌水稀释至20 m L,N组患者再次雾化吸入无菌水20 m L。观察两组患者麻醉开始前(t_(1))、单肺通气60 min(T_(2))、拔管后12 h(T_(3))时的血气分析指标[动脉血氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、乳酸(Lac)、氧合指数(P/F)]、血清炎症因子[白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)及核因子κB(NF-κB)]水平,麻醉开始5 min(t_(1))、T_(2)、手术结束后15 min(T_(3))时的呼吸及循环参数指标[血管外肺水(EVLW)、肺血管通透性指数(PVPI)、心率(HR)、每搏量(SV)],记录两组患者的拔管时间、拔管后12 h疼痛视觉模拟量表(VAS)评分、术后下床时间和拔管后12 h咽喉疼痛发生率以及不良反应发生情况。结果:两组患者t_(1)或t_(1)时的血气分析指标、血清炎症因子水平、呼吸及循环参数指标比较,差异均无统计学意义(P>0.05)。两组患者T_(2)、T_(3)时的PaO_(2)、PaCO_(2)、Lac、IL-6、TNF-α、NF-κB水平均显著高于同组t_(1)时,P/F均显著低于同组t_(1)时,而L组PaCO_(2)、Lac、IL-6�OBJECTIVE:To investigate the effects of lidocaine aerosol inhalation on perioperative pulmonary function,inflammation factor and related complications of patients with one-lung ventilation.METHODS:A total of 120 patients who were admitted to the Affiliated Hospital of Panzhihua University from January 2018 to May 2020 and planned to undergo partial pneumonectomy under general anesthesia and one-lung ventilation were selected.According to random number table method,they were divided into lidocaine aerosol inhalation group(group L)and sterile water aerosol inhalation group(group N),with 60 cases in each group.Two groups were given Midazolam injection0.1 mg/kg+Propofol injectable emulsion 2.0 mg/kg+Sufentanil citrate injection 0.4μg/kg to induce anesthesia.After the insertion of the double-lumen tracheal tube,group L was given aerosol inhalation of Lidocaine hydrochloride injection 1.5 mg/kg diluted to 20 m L with sterile water;group N was given aerosol inhalation of sterile water 20 m L at the flow rate of 2 L/min.Patients in both groups were continuously pumped with Propofol injectable emulsion 4-12 mg/(kg·h)+Remifentanil hydrochloride for injection 0.2-1μg/(kg·min)+Cisatracurium besilate for injection 0.05-0.1 mg/(kg·h)for anesthesia maintenance.Eight hours after operation,group L inhaled of Lidocaine hydrochloride injection 1.5 mg/kg diluted to 20 m L with sterile water again,and group N inhaled of sterile water 20 m L again.Arterial blood gas analysis indexes[arterial partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2)),lactic acid(Lac),oxygenation index(P/F)],serum inflammatory factors[interleukin 6(IL-6),tumor necrosis factorα(TNF-α)and nuclear factorκB(NF-κB)]were observed in 2 groups before anesthesia(T_(1)),60min of one-lung ventilation(T_(2)),and 12 h after extubation(T_(3)).Respiratory and circulatory parameters[extravascular lung water(EVLW),pulmonary vascular permeability index(PVPI),heart rate(HR),stroke volume(SV)]were also observed 5 min after anesthesia(t_(1)),T

关 键 词：利多卡因 雾化吸入 单肺通气 围术期 肺功能 炎症因子 并发症 

分 类 号：R563[医药卫生—呼吸系统] R974[医药卫生—内科学]