利多卡因对单肺通气患者肺保护的作用及对白介素1β、白介素6、白介素8水平的影响

Protective effect of lidocaine in patients with one-lung ventilation and its influence on levels of IL-1β,IL-6 and IL-8

目的探讨利多卡因在单肺通气患者肺保护作用及对白介素1β(IL-1β)、白介素-6(IL-6)、白介素-8(IL-8)水平的影响。方法回顾性分析选取河南大学第一附属医院医院2018年10月至2020年10月在全麻下进行肺叶切除术患者80例为研究对象,采用随机分组法分为观察组(n=41)与对照组(n=39)两组。观察组在麻醉诱导后立即给予1.5 mg/kg利多卡因静脉注射,对照组则给予等量生理盐水静脉注射,两组均以1.5 mg/(kg·h)的速度持续泵注直至手术结束。比较两组麻醉诱导前(T1)、OLV 45 min(T2)、OLV 90 min(T3)、术后2 h(T4)抗氧化指标水平[超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-PX)、丙二醛(MDA)]以及IL-1β、IL-6、IL-8水平。结果与T1比较,两组在T2、T3点时SOD和GSH-PX水平均降低,且观察组高于对照组(P<0.05),两组T1、T4时间点SOD和GSH-PX组间比较差异无统计学意义(P>0.05);与T1比较,T2、T4时间点两组MDA水平组内比较差异无统计学意义(P>0.05),而对照组T3点时MDA水平高于T1点,观察组T3点时MDA水平低于T1点(P<0.05),两组T1、T2、T4时间点MDA水平组间比较差异无统计学意义(P>0.05),而观察组T3点时MDA水平低于对照组(P<0.05)。两组T1点IL-1β、IL-6、IL-8水平比较差异均无统计学意义(P>0.05),与T1相比,对照组T2~T4的IL-1β、IL-6、IL-8水平均明显增加(P<0.05);观察组各时间点IL-1β、IL-6、IL-8水平组内比较差异无统计学意义(P>0.05),与对照组相比,观察组T2~T4的IL-1β、IL-6、IL-8水平均明显较低(P<0.05)。结论利多卡因对单肺通气患者有一定的肺保护作用,且能够降低促炎因子IL-1β、IL-6、IL-8水平,以此来减轻因单肺通气而导致的肺损伤,发挥肺保护作用。

【Objective】To investigate the protective effect of lidocaine in patients with one-lung ventilation and its influence on the levels of interleukin-1β,interleukin-6 and interleukin-8.【Methods】Our hospital recruited 80 patients undergoing lobectomy under general anesthesia from October 2018 to October 2020,and randomly divided them into observation group(n=41)and control group(n=39).The observation group was given an intravenous injection of lidocaine 1.5 mg/kg immediately after induction of anesthesia,and the control group was given an intravenous injection of the same amount of normal saline.Both groups were given a pump administration at a rate of 1.5 mg/(kg·h)until the end of the operation.The antioxidant index levels(superoxide dismutase,glutathione,malondialdehyde)and interleukin-1β,interleukin-6,and interleukin-8 levels between the two groups were compared before anesthesia induction(T1),OLV 45 min(T2),OLV 90 min(T3),postoperative 2 h(T4).【Results】Compared with T1,the total superoxide dismutase and glutathione peroxidase levels of the two groups decreased at T2 and T3,and the observation group was higher than the control group,the difference was statistically significant(P<0.05).The comparison of total superoxide dismutase and glutathione peroxidase between the two groups at T1 and T4 time points was not statistically significant(P>0.05);compared with T1,the comparison of the levels of malondialdehyde within the two groups at T2 and T4 time points was not statistically significant(P>0.05);the level of malondialdehyde at T3 in the control group was higher than that at T1,and the level of malondialdehyde at T3 in the observation group was lower than that at T1(P<0.05).The MDA level of the two groups at T1,T2,and T4 was not statistically significantly different(P>0.05),while the MDA level of the observation group at T3 was lower than that of the control group(P<0.05).The differences in the levels of interleukin-1β,interleukin-6,and interleukin-8 at T1 time point between the two groups were not statistically significant(P>0.05).Compared with T1,the levels of interleukin-1β,interleukin-6 and interleukin-8 at T2~T4 in the control group increased significantly(P<0.05).There were no statistically significant differences in the levels of interleukin-1β,interleukin-6 and interleukin-8 within the observation group at each time point(P>0.05).The levels of interleukin-1β,interleukin-6 and interleukin-8 at T2~T4 in the observation group were significantly lower than those in the control group,and the difference was statistically significant(P<0.05).【Conclusion】Lidocaine has a certain lung protective effect in patients with one-lung ventilation,and can reduce the levels of pro-inflammatory factors interleukin-1β,interleukin-6,and interleukin-8 during one-lung ventilation.