利多卡因联合肺保护性通气对止血带诱发下肢缺血再灌注肺损伤的保护作用  

Protective effect of lidocaine combined with lung protective ventilation on tourniquet-induced lower limbs ischemia-reperfusion lung injury

作　　者：张辉 邢瑞 蒿梦潇 张茂银 张稳稳 Zhang Hui;Xing Rui;Hao Mengxiao;Zhang Maoyin;Zhang Wenwen(Department of Anesthesiology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,China;School of Anesthesiology,Xuzhou Medical University,Xuzhou 221004,China)

机构地区：[1]徐州医科大学附属医院麻醉科,江苏徐州221002 [2]徐州医科大学麻醉学院,江苏徐州221004

出　　处：《实用药物与临床》2023年第1期30-34,共5页Practical Pharmacy and Clinical Remedies

基　　金：江苏省科技厅面上项目(BK20181153)。

摘　　要：目的探讨利多卡因联合肺保护性通气对止血带诱发下肢缺血再灌注肺损伤的保护作用。方法选取2020年6月-2021年12月徐州医科大学附属医院收治的108例行单侧下肢骨科需用止血带的手术患者,依照随机数字表法分为对照组和联合组,每组54例。两组患者均采用气管插管全身麻醉,术中采用肺保护性通气,联合组静脉注射利多卡因,对照组给予相同用量生理盐水。对比两组患者上止血带前15 min(T_(0)),松开止血带前1 min(T_(1)),松止血带后5 min(T_(2))和松止血带后30 min(T_(3))的血压、心率、肺泡动脉氧分压差(A-aDO_(2))、氧合指数(OI)、血浆丙二醛(MDA)、白细胞介素-8(IL-8)、血栓素B_(2)(TXB_(2))水平以及不良反应发生情况。结果与T_(0)时刻相比,两组T_(1)、T_(2)时刻平均动脉压均降低(P<0.05),且联合组T_(1)、T_(2)、T_(3)时刻平均动脉压均高于对照组(P<0.05);两组T_(1)、T_(2)、T_(3)时刻A-aDO_(2)均升高,且联合组T_(1)、T_(2)、T_(3)时刻A-aDO_(2)均低于对照组(P<0.05);与T_(0)时刻相比,两组T_(1)、T_(2)、T_(3)时刻OI均降低,且联合组T_(1)、T_(2)、T_(3)时刻OI均高于对照组(P<0.05);与T_(0)时刻相比,两组T_(1)、T_(2)时刻MDA、IL-8和TXB_(2)均升高,且联合组T_(1)和T_(2)时刻MDA、IL-8和TXB_(2)均低于对照组(P<0.05);两组患者苏醒时间及不良反应发生率比较,差异无统计学意义(P>0.05),联合组住院时间较对照组明显缩短(P<0.05)。结论利多卡因联合肺保护性通气能够减轻止血带诱发下肢缺血再灌注肺损伤,具有一定的保护作用。Objective To explore the protective effect of lidocaine combined with lung protective ventilation on tourniquet-induced lower limbs ischemia-reperfusion lung injury.Methods A total of 108 patients undergoing unilateral lower extremity surgery admitted to the Affiliated Hospital of Xuzhou Medical University from June 2020 to December 2021 were selected and divided into control group and combined group according to a random number table,with 54 cases in each group.Both groups of patients underwent general anesthesia with tracheal intubation,and lung-protective ventilation was given throughout the course;the combined group received intravenous lidocaine and the control group received the same amount of normal saline.The blood pressure,heart rate,alveolar artery partial pressure of oxygen(A-aDO_(2)),oxygenation index(OI),plasma malondialdehyde(MDA),interleukin-8(IL-8),thromboxane B_(2)(TXB_(2))levels and adverse reactions of the two groups of patients at 15 min before the tourniquet application(T_(0)),1 min before the tourniquet release(T_(1)),5 min after the tourniquet release(T_(2)),and 30 min after the tourniquet release(T_(3))were compared.Results Compared with T_(0),the average arterial pressure at time T_(1) and T_(2) in the two groups was decreased(P<0.05),and the average arterial pressure at T_(1),T_(2),and T_(3) in the combined group was higher than that in the control group(P<0.05).Compared with T_(0),the A-aDO_(2) was increased at T_(1),T_(2) and T_(3) in the two groups,and A-aDO_(2) at T_(1),T_(2) and T_(3) in the combined group was lower than that in the control group(P<0.05).Compared with T_(0),the OI at T_(1),T_(2) and T_(3) of the two groups was decreased,and the OI at T_(1),T_(2) and T_(3) of the combined group was higher than that of the control group(P<0.05).Compared with T_(0),the MDA,IL-8 and TXB_(2) of the two groups were increased at T_(1) and T_(2),and the MDA,IL-8 and TXB_(2) of the combined group were lower than those of the control group at T_(1) and T_(2)(P<0.05).There was no significant d

关 键 词：利多卡因 肺保护性通气 止血带 缺血再灌注 肺损伤 

分 类 号：R614[医药卫生—麻醉学]