体外循环期间应用利多卡因对心脏瓣膜置换术后患者谵妄的影响  

Effect of lidocaine on postoperative delirium in patients undergoing cardiac valve replacement under cardiopulmonary bypass

作　　者：静广建 刘照国[1] 于飞 孙敏[1] 苏明 王倩倩[1] 李晶 舒蕤 JING Guangjian;LIU Zhaoguo;YU Fei;SUN Min;SU Ming;WANG Qianqian;LI Jing;SHU Rui(Department of Anesthesiology,Affiliated Hospital of Binzhou Medical University,Binzhou 256603,China)

机构地区：[1]滨州医学院附属医院麻醉科,山东滨州256603

出　　处：《实用医学杂志》2022年第13期1637-1641,共5页The Journal of Practical Medicine

基　　金：国家自然科学基金青年科学基金资助项目(编号:81900269);滨州医学院“临床+X”项目(编号:BY2021LCX28)。

摘　　要：目的探讨体外循环(CPB)开始及复温时应用利多卡因对心脏瓣膜置换术后患者谵妄的影响,并探讨与脑氧饱和度(rSO_(2))的关系。方法择期行二尖瓣置换术患者60例,年龄34~75岁,性别不限,ASA分级Ⅱ或Ⅲ级,随机数字表法将患者分为两组(n=30):A组CPB开始时给与2%利多卡因4 mg/kg,复温时给与4 mg/kg;B组给与等量的生理盐水。采用CAM⁃ICU量表评定术后谵妄发生情况。术中持续采集患者双侧rSO_(2),计算rSO_(2)基础值、平均值、最低值及最低值较基础值下降百分比。记录拔管时间、ICU停留时间、住院时间、镇静镇痛药物用量和不良反应发生情况。结果与B组比较,A组rSO_(2)最低值较基础值下降百分比明显降低,rSO_(2)最低值显著升高,术后谵妄发生率明显降低,拔管时间、ICU停留时间显著缩短,术后舒芬太尼用量显著减少(P<0.05),其他结果差异无统计学意义(P>0.05)。结论CPB开始及复温时应用利多卡因可降低二尖瓣置换术后患者谵妄发生率,缩短拔管时间及ICU停留时间,减少术后舒芬太尼用量,可能与改善术中rSO_(2)有关。Objective To assess the effect of lidocaine,administrated at the beginning of cardiopulmo⁃nary bypass(CPB)and rewarming,on postoperative delirium after cardiac valve replacement;to explore the rela⁃tionship between the effect and regional cerebral oxygen saturation(rSO_(2)).Methods 60 patients aged 34~75 years old,males or femals,scheduled for mitral valve replacement,with American Society of Anesthesiologists(ASA)physical statusⅡorⅢ,were enrolled in the current study.Participants were randomized assigned into 2 groups(n=30 each):2%lidocaine 4mg/kg was administrated to participants of group A at the beginning and rewarming of CPB,while same amount of normal saline was administrated to participants of group B.The incidence of postop⁃erative delirium was assessed by Confusion Assessment Method for Intensive Care Unit(CAM⁃ICU).Bilateral rSO_(2) was collected consecutively throughout the course of the operation,the baseline,mean,minimum of rSO_(2) and the percentage of rSO_(2) decrease from baseline to minimum were calculated.The extubation time,the adverse reactions,the durations of ICU stay,the dosage of sedative and analgesic drugs and hospitalization were recorded.Results Compared with group B,the percentage of rSO_(2) decrease from baseline to minimum was significantly decreased,the minimal rSO_(2) was significantly increased,the incidence of postoperative delirium was significantly decreased,the extubation time and duration of ICU stay were significantly shortened,and the dosage of sufentanil was signifi⁃cantly decreased after operation in group A(P<0.05).There were no significant difference in other results(P>0.05).Conclusions Administrating lidocaine at the beginning and rewarming of CPB can reduce the incidence of delirium after mitral valve replacement,shorten the extubation time and duration of ICU stay,and decrease the dosage of sufentainil after operation,which may be related to the improvement of intraoperative rSO_(2).

关 键 词：体外循环 心脏瓣膜置换术 谵妄 利多卡因 

分 类 号：R614[医药卫生—麻醉学]