利多卡因预处理对膝关节镜手术中止血带引起的脂质过氧化的影响

Effects of lidocaine preconditioning on tourniquet-induced lipid peroxidation in arthroscopic knee surgery

目的探讨利多卡因预处理对膝关节镜手术患者止血带诱发脂质过氧化的影响。方法择期行膝关节镜手术的患者38例,年龄18～65岁,美国麻醉医师学会(ASA)分级Ⅰ或Ⅱ级,随机分入对照组和利多卡因组。利多卡因组患者先静脉注射利多卡因1.5mg/kg,再经微量静脉注射泵静脉注射2mg·kg-1·h-1×1h;对照组患者静脉注射等容0.9%氯化钠溶液。两组患者均在静脉注射后5min后予止血带充气。于止血带充气前(T0)、止血带放气10min(T1)和20min(T2)时测定静脉血血清丙二醛(MDA)、乳酸脱氢酶(LDH)和超氧化物歧化酶(SOD)水平。随访术后1、24h疼痛视觉模拟评分(VAS评分)。结果对照组在T1和T2时间点的LDH、SOD和MDA水平均显著高于同组T0时间点(P值均<0.05);利多卡因组在T1和T2时间点的MDA水平均显著低于同组T0时间点(P值均<0.05),而LDH、SOD水平的差异均无统计学意义(P值均>0.05)。利多卡因组在T1和T2时间点的MDA、LDH、SOD水平均显著低于对照组同时间点(P值均<0.05)。利多卡因组术后24h的疼痛VAS评分显著低于对照组(P<0.05)。结论利多卡因预处理可以减轻止血带引起的脂质过氧化损伤和术后疼痛。

Objective To investigate the effects of lidocaine preconditioning on lipid peroxidation caused by tourniquet application during arthroscopic knee surgery. Methods Thirty-eight patients （age 18- 65 years, American Society of Anesthesiologist physical status I or Ⅱ ） undergoing elective arthroscopic knee surgery were randomly assigned to control group （n = 19） and lidocaine group （n = 19）. In lidocaine group, patients were pretreated with intravenous lidocaine （1. 5 mg/kg） 5 minutes before the tourniquet was roped, and then with infusion of lidocaine 2 mg ~ kg-~ ~ h-~ for 1 hour. The patients in control group received isovolume normal saline. Venous blood was taken before anesthesia （T0）, at 10 （T1） and 20 minutes （T2） after tourniquet release for the measurements of malondialdehyde （ MDA）, lactate dehydrogenase （LDH） and superoxide dismutase （ SOD）. Postoperative pain was assessed with visual analogue scale （VAS） score 1 h and 24 h postoperatively. Results In control group, the levels of serum MDA, LDH, and SOD were all significantly higher at T1 and T2 than those at To （all P〈0.05）. In lidocaine group, MDA concentration was significantly lower at T1 and T2 than that at To （all P〈 0.05） ; there were no significant changes in LDH and SOD activity at T1 and T2 compared with that at To （all P〉 0.05）. MDA, L.DH and SOD levels in lidocaine group were significantly lower than those in control group at T1 and T2（all P〈0. 05）. VAS scores in lidocaine group were significantly lower .than those in control group 24 h postoperatively （P〈0.05）. Conclusion Precondition with lidocaine can attenuate lipid peroxidation induced by tourniquet application and relieve postoperative pain.