利多卡因预处理对颅内肿瘤切除术患者血中丙二醛和内皮素的影响

The effect of lidocaine pretreatment to malondialdehyde and endothelin of patients who accepeted brain tumor removing

目的观察不同时间点给予利多卡因预处理后颅内肿瘤切除术患者血中丙二醛(MDA)和内皮素(ET)的变化及神经功能恢复情况,探讨预处理的时机。方法选取2009年3月至2011年9月该院神经外科60例择期行颅内肿瘤切除术患者,随机分为A组(术前48h)、B组(术前24h)、C组(术前12h)、D组(0h即诱导时)、E组(对照)、F组(空白对照),每组10例。A、B、C、D组均用1%利多卡因1.5mg/kg按预定时间静脉注射预处理后常规诱导麻醉,E组常规诱导麻醉后辅以1%利多卡因2.5mg·kg-1·h-1静脉注射麻醉,F组术前、术中均不使用利多卡因。记录各组患者术后自主呼吸时间、清醒时间及气管导管拔管时间,采用美国国立卫生研究院卒中量表(NIHSS)进行神经功能缺损评估,检测血中MDA及ET的水平。结果 C组患者的自主呼吸时间、清醒时间和气管导管拔管时间较其他组稍短,但差异无统计学意义(P>0.05)。术前1dNIHSS评分各组间差异无统计学意义(P>0.05),术后14dC组与E、F组比较差异有统计学意义(P<0.05)。麻醉诱导前各组间ET和MDA值差异无统计学意义(P>0.05);手术后C组与其他组ET和MDA值比较,差异均有统计学意义(P<0.05)。结论缺血前12h予1%利多卡因1.5mg/kg静脉注射预处理后颅内肿瘤切除术患者的血中MDA及ET水平显著降低,这可能是该组患者术后脑神经功能恢复较快的机制之一。

Objective To observe effect of lidocaine pretreatment to malondialdehyde（MDA） and endothelin（ET） of patient accepeted brain tumor removing and discuss the optimized pretreatment time. Methods 60 brain tumor patients in the hospital from March 2009 to September 2011. according to the different pretreatment time,the patients were randomly divided into five groups： group A（preoperative 48 h） ,group B（preoperative 24 h） ,group C（preoperative 12 h） ,group D（0 h or anesthesia induced） ,group E （ control group） and group F（blank control group）, 10 cases in each group. Group A,B, C, D with 1% lidocaine 1.5 mg/kg intrave- nous pretreatment on schedule,then induced conventional anesthesia group E were supplemented with 1% lidocaine 2.5 mg·kg-1 · h-1 intravenous injection after anesthesia induction;group F was performed routine program without lidocaine. The spontaneous breathing time,awake time and tracheal extubation time was recorded,while NIHSS score for evaluation of neural function defect was applied,and peripheral serum level of MDA and ET was detected by colorimetric technique and radio-immunity. Results In group C, the spontaneous breathing time,awake time and tracheal extubation time were shorter than other groups, but the difference had no statistically significant（P~〉0.05）. There was no significant difference among each group in the aspect of NIHSS score 1 day before surgery（P^0.05）,after 14 days of operation, NIHSS of group C was statistically lower than that of group E and group F （P〈0.05）. Before anesthesia induction, there was no significant difference among groups （P〉 0.05）. MDA and ET content in group C was significantly lower than those in other groups after surgery（P〈0.05）. Conclusion Lidocaine given 12 h before cerebral ischemia has varying degree protection against cerebral ischemia-reperfusion injury. The protection has relation with the decrease of MDA and ET content.