利多卡因联合丙泊酚静脉麻醉对单肺通气肺肿物患者脑氧代谢和围手术期神经认知紊乱的影响  

Effects of Lidocaine Combined with Propofol on Cerebral Oxygen Metabolism and Perioperative Neurocognitive Disorder in Patients with Lung Masses on One-lung Ventilation

作　　者：张建友 杨倩 李士通[2] 邢智 王溢鑫 杨大威 ZHANG Jianyou;YANG Qian;LI Shitong;XING Zhi;WANG Yixin;YANG Dawei(Department of Anesthesiology,Affiliated Hospital of Yangzhou University,Yangzhou 225000,China;Department of Anesthesiology,the First People′s Hospital Affiliated to Shanghai Jiaotong University,Shanghai 200080,China)

机构地区：[1]扬州大学附属医院麻醉科,江苏扬州225000 [2]上海交通大学附属第一人民医院麻醉科,上海200080

出　　处：《医学综述》2023年第7期1437-1442,共6页Medical Recapitulate

基　　金：扬州市医学重点人才项目(第77号)。

摘　　要：目的探讨胸腔镜肺部手术中利多卡因联合丙泊酚静脉麻醉对单肺通气患者脑氧代谢和围手术期神经认知紊乱(PND)的影响。方法选取2018年8月至2020年3月于扬州大学附属医院择期在全身麻醉下行胸腔镜下肺叶或肺段切除术的60例肺肿物患者,按随机数字表法均分为利多卡因组和对照组,每组30例。利多卡因组在麻醉诱导时静脉输注利多卡因1.5 mg/kg,随后静脉泵注利多卡因1.5 mg/(kg·h)和丙泊酚维持麻醉深度。对照组以等量0.9%氯化钠注射液代替利多卡因,其余麻醉用药与利多卡因组一致。所有患者均采集双肺通气以及单肺通气30 min桡动脉血和颈内静脉血进行血气分析,并计算上述时间点肺内分流率(Qs/Qt)、动脉-颈内静脉血氧含量差(Da-jvO_(2))和脑氧摄取率(CERO_(2))。记录术中丙泊酚、瑞芬太尼用量以及患者术后苏醒时间。结果两组患者术前肺功能、围手术期相关指标、血流动力学指标比较差异均无统计学意义(P>0.05)。对照组与利多卡因组单肺通气Qs/Qt均明显高于双肺通气[(26.6±8.6)%比(12.7±6.0)%、(26.0±6.9)%比(14.0±3.7)%](P<0.05),而单肺通气PaO_(2)均明显低于双肺通气[(204±109)mmHg(1 mmHg=0.133 kPa)比(461±97)mmHg、(196±103)mmHg比(466±52)mmHg](P<0.05)。利多卡因组单肺通气SjvO_(2)明显低于对照组[(72.7±9.5)%比(77.8±8.7)%](P<0.05),而Da-jvO_(2)、CERO_(2)明显高于对照组[(48.8±11.3)ml/L比(43.0±10.6)ml/L、(28.2±7.7)%比(24.1±7.1)%](P<0.05)。利多卡因组与对照组PND发生率比较差异无统计学意义[3.3%(1/30)比6.7%(2/30)](P>0.05)。与对照组比较,利多卡因组术中丙泊酚、瑞芬太尼的泵注用量明显减少[(118±26)mg比(196±32)mg、(148±63)μg比(288±58)μg](P<0.01)。两组拔管时间比较差异无统计学意义(P>0.05)。结论利多卡因联合丙泊酚静脉麻醉可使单肺通气患者脑氧代谢轻度升高,但对PND无影响。Objective To explore the effects of lidocaine combined with propofol intravenous anesthesia on cerebral oxygen metabolism and perioperative neurocognitive disorders(PND)in patients with one lung ventilation undergoing thoracoscopic lung surgery.Methods A total of 60 patients with lung masses who underwent thoracoscopic lobectomy under general anesthesia were selected from the Affiliated Hospital of Yangzhou University from Aug.2018 to Mar.2020 and were divided into a lidocaine group and a control group according to the random number table method,with 30 cases in each group.In lidocaine group,lidocaine 1.5 mg/kg was infused intravenously during anesthesia induction,and then lidocaine 1.5 mg/(kg·h)and propofol were pumped intravenously to maintain the depth of anesthesia.The control group replaced lidocaine with the same amount of 0.9%sodium chloride injection.And the rest of the anesthesia was consistent between the two groups.All patients were collected from radial artery blood and internal jugular vein blood for blood gas analysis at dual-lung ventilation and 30 minutes of one-lung ventilation,and the intrapulmonary shunt rate(Qs/Qt),the difference of arterial-internal jugular vein blood oxygen content(Da-jvO_(2))and cerebral oxygen uptake rate(CERO_(2))were calculated at the above time points.The dosage of intraoperative propofol and remifentanil and the postoperative wake-up time were recorded.Results There was no significant difference between the two groups in preoperative lung function,perioperative related indexes and hemodynamic indexes(P>0.05).The Qs/Qt of one-lung ventilation was significantly higher than that of dual-lung ventilation[(26.6±8.6)%vs(12.7±6.0)%,(26.0±6.9)%vs(14.0±3.7)%](P<0.05),while the PaO_(2) of one-lung ventilation was significantly lower than that of dual-lung ventilation[(204±109)mmHg vs(461±97)mmHg,(196±103)mmHg vs(466±52)mmHg](P<0.05).SjvO_(2) of one-lung ventilation in the lidocaine group was significantly lower than that in the control group[(72.7±9.5)%vs(77.8±8.7)%](

关 键 词：单肺通气 利多卡因 丙泊酚 脑氧代谢 围手术期 神经认知紊乱 

分 类 号：R614[医药卫生—麻醉学]