静脉泵注利多卡因对老年高血压患者下肢缺血再灌注致远隔器官肺损伤的影响  

Effect of intravenous infusion of lidocaine on lung injury caused by lower ischemia and reperfusion in elderly patients with hypertension

作　　者：李青青 陈雪莹 徐桂萍[1] Li Qingqing;Chen Xueying;Xu Guiping(Department of Anesthesiology,People's Hospital of Xinjiang Uygur Autonomous Region,Xinjiang Clinical Research Center for Anesthe-sia Management,Urumqi 830001,China)

机构地区：[1]新疆维吾尔自治区人民医院麻醉科,新疆麻醉管理临床医学研究中心,乌鲁木齐830001

出　　处：《国际麻醉学与复苏杂志》2023年第3期264-268,共5页International Journal of Anesthesiology and Resuscitation

基　　金：新疆维吾尔自治区重点研发任务专项(2022B03009⁃4)。

摘　　要：目的观察静脉泵注利多卡因对老年高血压患者下肢缺血再灌注致肺损伤的影响。方法选取新疆维吾尔自治区人民医院2021年6月至2022年6月60例拟行单侧膝关节置换手术的老年高血压患者,所有患者均在全麻下完成手术。按随机数字表法将患者分为对照组(C组,30例)和利多卡因组(L组,30例)。L组麻醉诱导时静脉注射利多卡因1.5 mg/kg,随后以2 mg·kg−1·h−1的速度输注至松止血带时,C组在相同时间点给予等容量生理盐水。在术前(T0)、松止血带后1 min(T1)、术后1 h(T2)经桡动脉抽取动脉血1 ml,进行血气分析检测PaO_(2)、PaCO_(2),计算呼吸指数(respiratory index,RI)、氧合指数(oxygen⁃ation index,OI)以及肺泡⁃动脉氧分压差(difference of alveoli⁃arterial oxygen pressure,P_(A-a)DO_(2))。根据OI诊断是否发生肺损伤,记录各时点肺损伤发生例数,并记录松止血带前后血压、心率、SpO_(2)、P_(ET)CO_(2)等生命体征变化。结果与C组比较,L组患者在T1和T2时PaO_(2)、PaCO_(2)、P_(A-a)DO_(2)、RI、OI差异均有统计学意义(P<0.05),其中L组PaO_(2)和OI值高于C组,L组PaCO_(2)、P_(A-a)DO_(2)、RI低于C组。与L组比较,C组在T1发生肺损伤的例数明显增多,差异有统计学意义(P<0.05)。与L组比较,C组的生命体征(血压、P_(ET)CO_(2)、心率、SpO_(2))的变化差更大,差异有统计学意义(P<0.05)。结论静脉泵注利多卡因可以减轻老年高血压患者止血带引起的肢体缺血再灌注致远隔器官肺损伤,改善患者肺功能。Objective To observe the effect of intravenous injection of lidocaine on lung injury caused by lower ischemia⁃reperfusion in elderly patients with hypertension.Methods Elderly patients with hypertension who were scheduled for uni⁃lateral knee replacement from June 2021 to June 2022 were selected.All the patients finished surgery under general anesthesia.According to the random number table method,they were divided into two groups(n=30):a control group(group C)and a lidocaine group(group L).Group L was intravenously injected with lidocaine at 1.5 mg/kg for anesthesia induction followed by intravenous infusion at 2 mg·kg−1·h−1,until the tourniquet was deflated.Meanwhile,group C was administered with the same volume of normal saline.Then,1 ml of arterial blood was drawn via the radial artery before operation(T0),1 min after deflation of the tourniquet(T1),and 1 h after surgery(T2).Blood gas analysis was used to detect the arterial blood partial oxygen pressure(PaO_(2)),carbon dioxide partial pressure(PaCO_(2)),and to calcu⁃late respiratory index(RI),oxygenation index(OI),and the difference of alveoli⁃arterial oxygen pressure(P_(A-a)DO_(2)).The OI was used to evaluate the presence of lung injury.The number of lung injury cases was recorded at each time point.The changes of blood pressure,heart rate,pulse oxygen saturation(SpO_(2)),and end⁃tidal carbon dioxide partial pressure(P_(ET)CO_(2))were recorded.Results Compared with group C,patients in group L showed statistical differences in PaO_(2),PaCO_(2),P_(A-a)DO_(2),RI,and OI at T1 and T2(P<0.05),where group L presented increases in PaO_(2) and OI,as well as decreases in PaCO_(2),P_(A-a)DO_(2),and RI,compared with group C.Compared with group L,a significant increased number of lung injury cases were observed in group C(P<0.05).The changes of vital signs(blood pressure,P_(ET)⁃CO_(2),heart rate and SpO_(2))in group C were more obviously than those in group L(P<0.05).Conclusions Intravenous infusion of lido⁃caine can relieve lung injury caused by lowe

关 键 词：利多卡因 肺损伤 老年人 高血压 缺血再灌注 

分 类 号：R614[医药卫生—麻醉学]