利多卡因对术后肺部并发症中高风险患者的肺保护作用

The lung protective effects of intravenous lidocaine on patients at intermediate to high risk of postoperative pulmonary complications

目的研究利多卡因对术后肺部并发症(postoperative pulmonary complication,PPC)中高风险患者血清生物标志物、炎性因子、肺部氧合情况和PPC的影响,探讨利多卡因对PPC中高风险患者的肺保护作用。方法选择124例行全身麻醉气管插管,年龄≥18岁,ASA分级Ⅱ、Ⅲ级,PPC中高风险的患者,按随机数字表法分为利多卡因组(L组)和生理盐水组(C组),每组62例。L组在麻醉诱导后即刻静脉给予利多卡因1.5 mg/kg,术中持续泵注利多卡因(1 mg·kg^-1·h^-1),C组给予等量生理盐水。分别于麻醉诱导前(T0)、机械通气1 h(T1)、机械通气2 h(T2)、术毕(T3)、术后24 h(T4)检测患者血清克拉拉细胞分泌蛋白(clara cell secretory proteins,CC16)、IL-6、IL-10水平,行动脉血气分析,计算氧合指数(oxygen index,OI)、肺泡动脉氧分压差(alveolar-arterial oxygen difference,A-aDO2)、呼吸指数(respiratory index,RI)。记录术中机械通气时间、术中液体输注情况、患者住院时长、ICU入住率、术后30 d PPC发生率。结果两组患者T2、T3时血清CC16、IL-6、IL-10水平及L组T4时血清IL-6水平高于T0(P<0.05)。L组患者T2、T3时血清CC16水平及T3、T4时血清IL-6水平低于C组(P<0.05)。两组患者各时点血清IL-10水平比较,差异无统计学意义(P>0.05)。两组患者T1、T2时OI及L组T3时OI高于T0(P<0.05),T1、T2、T3时A-aDO2和RI高于T0(P<0.05)。T2、T3时L组OI值高于C组,A-aDO2值低于C组(P<0.05)。两组各时点RI差异无统计学意义(P>0.05)。两组患者术中液体输注情况、输血率、机械通气时间、ICU入住率比较,差异无统计学意义(P>0.05)。L组住院时间短于C组(P<0.05),术后30 d PPC发生率低于C组(P<0.05)。结论静脉使用利多卡因可能通过抑制炎症反应减轻PPC中高风险患者行腹部大手术后的肺损伤,改善肺部氧合,降低围手术期PPC发生率,改善患者预后。

Objective This research aims to study the lung protective effects of intravenous lidocaine in the patients with moderate and high risk of postoperative pulmonary complication(PPC),by observing changes of plasma markers of lung injury and inflammatory mediators,pulmonary oxygenation and PPC.Methods One hundred and twenty four patients scheduled for endotracheal intubation under general anesthesia,age≥18 years old,American Society of Anesthesiologists(ASA)physical statusⅡ,Ⅲ,with an moderate-to-high risk for PPC.They were divided into two groups(n=62),according to the random number table method.Lidocaine group(group L),bolus injection of 1.5 mg/kg lidocaine was given to patients at induction of anesthesia with subsequent continued infusion of 1 mg·kg^-1·h^-1 during surgery process.Control group(group C),equivalent amount of normal saline rather than lidocaine was given to patients.Venous blood for plasma markers of lung injury and inflammatory mediators were collected at the following time points:before induction of anesthesia(T0),1 h after mechanical ventilation(T1),2 h after mechanical ventilation(T2),the end of surgery(T3),24 h after surgery(T4).These mediators included clara cell secretory protein(CC16),interleukin(IL-6)and IL-10.Arterial blood gas analysis were recorded at T0,T1,T2 and T3.The oxygen index(OI),alveolar-arterial oxygen difference(A-aDO2),respiratory index(RI)were calculated.Intraoperative mechanical ventilation time,intraoperative fluid intake and outflow,length of hospital stay,intensive care unit(ICU)admission rate,and pulmonary complications within 30 d after surgery were also recorded.Results The results demonstrated that compared with T0,the plasma concentrations of CC16,IL-6,IL-10 at T2,T3 in both group and IL-6 plasma level at T4 in group L were higher(P<0.05).Compared with group C,the plasma levels of CC16 in group L at T2,T3 were lower(P<0.05)and IL-6 levels at T3,T4 in group L were lower(P<0.05),There was no significant difference in IL-10 levels between the two groups at each time point(P>0.05).compared with T0,the OI values at T1,T2 in both group and OI values at T3 in group L were higher(P<0.05).A-aDO2 and RI values at T1,T2 and T3 were higher than those at T0 in both group.Compared with group C,OI values in group L was significantly higher than those in group C at T2,T3 while A-aDO2 values were lower at T2,T3(P<0.05).There was no significant difference in RI values between the two groups at each time point(P>0.05).There was no significant difference in intraoperative fluid infusion,transfusion rate,ventilation time,ICU admission rate.the length of hospitalization in group L was shorter than that ingroup C(P<0.05).The incidence of PPCs in group L was lower than that in group C during postoperative 30 days(P<0.05).Conclusions Intravenous use of lidocaine may attenuate lung injury on patients at intemediate to high risk of PPC by inhibiting inflammatory response and improve pulmonary oxygenation,reduce the incidence of PPC and improve the prognosis of the patients.