利多卡因对老年患者腹腔镜胃癌手术血清NSE和S-100β蛋白含量的影响

Effects of Lidocaine on Serum NSE and S100β Contents in Elderly Patients Undergoing Laparoscopic Gastric Cancer Surgery

目的探讨不同剂量的利多卡因对老年患者腹腔镜胃癌手术围术期血清神经元特异性烯醇化酶(NSE)和S-100β蛋白含量的影响。方法选取择期行腹腔镜辅助下胃癌根治术的老年患者60例,按随机数字表法将其分为对照组(C组)、利多卡因1组(L1组)、利多卡因2组(L2组)。L1、L2组分别在麻醉诱导前5min缓慢静脉注射利多卡因1.0mg·kg^(-1)、2.0mg·kg^(-1),继之分别以1.0mg·kg^(-1)·h-1和2.0mg·kg^(-1)·h-1持续泵注至术毕。对照组以生理盐水1.0mg·kg^(-1)代替利多卡因。3组的其他麻醉与管理相同。麻醉诱导前(T1)、术毕时(T2)、术后1d(T3)、术后3d(T4)4个时点采静脉血3mL,ELISA法测血清中NSE及S-100β蛋白含量。结果 NSE及S-100β蛋白含量比较:C组T2、T3较T1时均显著升高(P<0.05),T4时较T1时差异无统计学意义(P>0.05);L1和L2组不同时点组内比较差异均无统计学意义(P>0.05);L1和L2组较C组在T2和T3时均明显降低(P<0.05);L1和L2组不同时点组间比较差异无统计学意义(P>0.05)。结论利多卡因可降低老年患者腹腔镜胃癌手术围术期血清NSE及S-100β蛋白含量,减轻老年患者腹腔镜胃癌手术脑细胞损伤。其量-效关系及机制有待进一步研究。

Objective To study the effects of different doses of lidocaine on perioperative serum neuron specific enolase(NSE)and S100βlevels in elderly patients undergoing laparoscopic gastric cancer surgery.Methods Sixty elderly patients scheduled for laparoscopic gastric cancer surgery were divided into three groups,with 20 patients in each group.The group L1,group L2 and group C were given slow intravenous injection of 1mg·kg^(-1) lidocaine,2mg·kg^(-1) lidocaine and 1mg·kg^(-1) normal saline 5minutes before anesthesia induction,followed by continuous intravenous infusion of 1mg·kg^(-1) lidocaine,2mg·kg^(-1) lidocaine and 1mg·kg^(-1) normal saline until the end of surgery,respectively.Venous blood samples were collected before anesthesia induction(T1),at the end of surgery(T2),1day after surgery(T3)and 3days after surgery(T4),and serum NSE and S100βlevels were measured by ELISA.Results In group C,compared with T1,significant increase in serum NSE and S100βlevels was observed at T2 and T3(P<0.05),but not at T4.However,there were no significant differences among different time points in groups L1 and L2.Compared with group C,serum NSE and S100βlevels significantly decreased at T2 and T3in groups L1 and L2(P<0.05).Conclusion Lidocaine can decrease perioperative serum NSE and S100βlevels and reduce brain cell damage in elderly patients undergoing laparoscopic gastric cancer surgery.However,the dose-effect relationship and mechanism of lidocaine action need further studied.