利多卡因对老年患者腹腔镜手术的脑保护作用

Cerebral Protection by Lidocaine in Elderly Patients Undergoing Laparoscopic Surgery

目的观察利多卡因对CO_2气腹后老年患者血清神经元特异性烯醇化酶(NSE)和S-100β蛋白浓度的影响以及脑保护作用。方法将择期行腹腔镜辅助下胃癌根治术的老年患者40例按随机数字表法分为对照组(C组)、利多卡因组(L组),每组20例。麻醉诱导前,L组以1mg·kg-1·h-1利多卡因持续泵注至气腹结束时停止;C组在麻醉诱导前以等量生理盐水持续泵注至气腹结束时停止。于手术前(T1)、气腹建立后30min(T2)、气腹解除即刻(T3)和气腹解除后1h(T4)等时点缓慢采静脉血3mL,ELISA法测血清NSE及S-100β蛋白浓度。结果C组T2—T4时点血清NSE及S-100β蛋白浓度较T1时点均显著升高(P<0.05),且在T4时点达峰值;L组不同时点血清NSE及S-100β蛋白浓度比较差异均无统计学意义(P>0.05)。与C组比较,L组血清NSE及S-100β蛋白浓度在T2—T4时点均明显降低(P<0.05)。与T1时点比较,2组T2—T4时点PCO_2、Lac浓度差异均无统计学意义(P>0.05);不同时点2组组间PCO2、Lac浓度比较均差异无统计学意义(P>0.05)。结论利多卡因可降低老年患者腹腔镜手术血清NSE及S-100β蛋白浓度,具有脑保护作用。

Objective To observe the effects of lidocaine on serum neuron specific enolase （NSE） and S10013 protein concentrations and cerebral protection in elderly patients after carbon dioxide pneumoperitoneum. Methods Forty elderly patients scheduled for laparoscopic gastrectomy were divided into two groups,with 20 patients in each group. Before anesthesia induction, the lidocaine group （group L） was given continuous infusion of lidocaine at 1 mg·kg^-1·h^-1 until the end of the carbon dioxide pneumoperitoneum. The control group （group C） received the same amount of normal saline. Serum samples （3 mL） were collected before surgery （T1）, 30 minutes after pneumoperitoneum（T2）, at the end of pneumoperitoneum （T3） and 1 hour after the end of pneumoperitoneum（T4）. The levels of serum NSE and S100β protein were detected by ELISA. Results Compared with Tl,serum NSE and S100β protein levels increased at T2-T4 with a peak at T4 in group C（P〈0.05）. No significant differences in serum NSE and $10013 protein levels were found among different time points in group L（P〉0.05）. Compared with group C, serum NSE and S100β protein levels lowered in group L at T2-T4（P〈0.05）. Compared with T1 ,PCO2 and lactate levels were not changed at T2-T4 in both groups（P〉0.05）. In addition,there were no significant differences in PCO2 and lactate levels between the two groups at the same time point. Conclusion Lidoeaine ean reduce serum NSE and S10013 protein levels and exert cerebral protection in elderly patients undergoing laparoscopic surgery.