利多卡因复合肺保护性通气对止血带诱发下肢缺血再灌注肺损伤的保护作用

Protective Effect of Lidocaine Combined with Lung Protective Ventilation on Tourniquet-in-duced Lower Limbs Ischemia-reperfusion Lung Injury

【目的】探讨利多卡因复合肺保护性通气对止血带诱发下肢缺血再灌注肺损伤的保护作用。【方法】选取2019年6月至2020年5月本院诊治的108例拟行单侧下肢手术患者,按照随机数表法分为对照组和联合组,每组54例。两组患者均采用腰硬联合麻醉,全程给予肺保护通气,联合组静脉注射利多卡因,对照组给予相同用量生理盐水。比较两组患者不同时间点平均动脉压、心率、肺泡动脉氧分压差(A-aD0_(2))、氧合指数(OI)、血浆丙二醛(MDA)、白细胞介素-8(IL-8)、血栓素B_(2)(TXB_(2))水平及不良反应发生率。【结果】两组松止血带后5 min(T_(1))时刻平均动脉压均降低,且联合组T_(1)和松止血带后30 min(T_(2))时刻平均动脉压均高于对照组(P<0.05);两组T_(1)和T_(2)时刻A-aDO_(2)均升高,但联合组T_(1)和T_(2)时刻A-aD0_(2)均低于对照组(P<0.05),两组T_(1)和T_(2)时刻OI均降低,但联合组T_(1)和T_(2)时刻OI均高于对照组(P<0.05);两组T_(1)时刻MDA、IL-8和TXB_(2)均升高,但联合组T_(1)和T_(2)时刻MDA、IL-8和TXB_(2)均低于对照组(P<0.05);两组不良反应发生率比较差异无统计学意义(P>0.05)。【结论】利多卡因复合肺保护性通气能够减轻止血带诱发下肢缺血再灌注肺损伤,具有一定的保护作用。

【Objective】To explore the protective effect of lidocaine combined with lung protective ventilation on tourniquet-induced lower limbs ischemia-reperfusion lung injury.【Methods】A total of 108 patients undergoing unilateral lower extremity surgery admitted to the hospital from June 2019 to May 2020 were selected and divided into the control group and the observation group according to a random number table,with 54 cases in each group.Both groups were treated with combined spinal-epidural anesthesia,and lung-protective ventilation were given throughout the course.While the combined group received intravenous lidocaine and the control group received the same amount of normal saline instead.The blood pressure,heart rate,alveolar artery partial pressure of oxygen(A-aD0_(2)),oxygenation index(OI),plasma malondialdehyde(MDA),interleukin-8(IL-8),thromboxane B_(2)(TXB_(2))levels and ad-verse reactions of the two groups of patient's at different time points were compared.【Results】The average arterial pressure at 5 minutes after loosening the tourniquet(T_(1))in the two groups were reduced.While the average arterial pressure at T_(1) and 30 minutes after loosening the tourniquet(T_(2))in the observation group were higher than that in the control group(P<0.05).The A-aD0_(2) increased at T_(1) and T_(2) in the two groups,and A-aD0_(2) at T_(1) and T_(2) in the observation group were lower than that in the control group(P<0.05).The OI at _(1) and T_(2) of the two groups decreased,however,the OI at and T_(2) of the observation group were higher than that of the control group(P<0.05).The MDA,IL-8 and TXB_(2) of the two groups increased at T_(1),and the MDA,IL-8 and TXB_(2) of the observation group were lower than those of the control group at T_(1) and T_(2)(P<0.05).There were no significant difference in the incidence of adverse reactions between the two groups(P〉0.05).【Conclusion】Lidocaine combined with lung protective ventilation can reduce the tourniquet-induced lower limbs ischemia-reperfusion lung injury,and it has a certain protective effect.