氯胺酮和利多卡因对膝关节置换术患者止血带所致缺血再灌注损伤后自由基生成的影响

Effects of ketamine and lidocaine on free radical production after tournique-induced ischemiareperfusion injury in patients undergoing knee arthroplasty

目的评估静脉注射利多卡因与氯胺酮对膝关节置换术患者止血带所致缺血再灌注损伤后自由基生成的影响。方法纳入行膝关节置换术的患者120例,依据随机数字表法分为利多卡因组、氯胺酮组和生理盐水组,每组40例。利多卡因组患者于麻醉诱导前10 min缓慢静脉注射利多卡因1 mg/kg;氯胺酮组患者于麻醉诱导前10 min缓慢静脉注射氯胺酮0.5 mg/kg;生理盐水组患者静脉注射0.9%氯化钠注射液10 mL。记录3组患者麻醉前(T0)、输注干预药物后5 min(T_(1))、上止血带后30 min(T2)、撤止血带后15 min(T3)的心率(HR)、收缩压(SBP)、舒张压(DBP)。于T_(0)、T_(2)、T_(3)时点抽取外周静脉血检测全血乳酸水平和缺血修饰白蛋白(IMA)水平。记录患者拔管时间,术中低血压和高血压发生率,术后恶心呕吐、苏醒期躁动、苏醒延迟等不良反应发生率。结果最终共纳入113例患者,利多卡因组、氯胺酮组和生理盐水组分别纳入38例、38例、37例患者。T_(1)时点,氯胺酮组患者SBP、DBP、HR均高于利多卡因组和生理盐水组(P<0.05),利多卡因组和生理盐水组患者SBP、DBP、HR的比较差异无统计学意义(P>0.05)。T_(2)时点,氯胺酮组SBP、DBP较利多卡因组和生理盐水组明显升高(P<0.05),HR比较差异无统计学意义(P>0.05)。T3时点,3组患者SBP、DBP、HR比较差异无统计学意义。T_(2)、T_(3)时点,利多卡因组患者血乳酸和IMA水平明显低于氯胺酮组和生理盐水组,而氯胺酮组低于生理盐水组,差异有统计学意义(P<0.05)。3组患者拔管时间,术中高血压和低血压发生率,术后恶心呕吐、苏醒期躁动、苏醒延迟发生率比较差异亦无统计学意义(P>0.05)。结论利多卡因和氯胺酮均能对抗膝关节置换术患者止血带所致缺血再灌注损伤,但利多卡因效果更明显。

Objective To evaluate the effects of different doses of ketamine and lidocaine on free radical production after tournique-induced ischemia-reperfusion injury in patients undergoing knee arthroplasty.Methods A total of 120 patients who planned to undergo knee arthroplasty were included in this study.Patients were randomly divided into the lidocaine group,the ketamine group and the saline group,with 40 patients in each group.The lidocaine group was given lidocaine intravenously with 1 mg/kg 10 min before anesthesia induction.In the ketamine group,0.5 mg/kg ketamine was slowly injected intravenously 10 min before anesthesia induction.The saline group was intravenously injected with 0.9%sodium chloride 10 mL.Data of systolic blood pressure(SBP),diastolic blood pressure(DBP)and heart rate(HR)of three groups were recorded before anesthesia(T_(0)),5 min after infusion of intervention drugs(T_(1)),30 min after applying tourniquet(T_(0)),and 15 min after removing tourniquet(T_(3)).Peripheral venous blood samples were collected at T_(0),T_(2) and T_(3) to detect lactic acid level and ischemia modifier albumin(IMA)level in the three groups.The time of extubation,incidence of intraoperative hypotension,intraoperative hypertension,postoperative nausea and vomiting,agitation during recovery,delayed awakening and other adverse reactions were recorded.Results A total of 113 patients were enrolled,including 38 in the lidocaine group,38 in the ketamine group,and 37 in the saline group,respectively.At T;,SBP,DBP and HR were higher in the ketamine group than those in the lidocaine group and saline group(P<0.05).There were no significant differences in SBP,DBP and HR between the lidocaine group and the saline group(P>0.05).At T_(2),SBP and DBP were significantly higher in the ketamine group than those in the lidocaine group and the saline group(P<0.05),but there was no significant difference in HR between the two groups(P>0.05).At T_(3),there were no significant differences in SBP,DBP and HR between the 3 groups.At T_(2) and T_(3),the serum levels of lactic acid and IMA were significantly lower in the lidocaine group than those of the ketamine group and the saline group,while the level was significantly lower in the ketamine group than that of the saline group(P<0.05).There were no significant differences in the time of extubation,intraoperative hypertension,incidence of intraoperative hypotension,postoperative nausea and vomiting,agitation in recovery period and delay in recovery between the three groups(P>0.05).Conclusion Both lidocaine and ketamine can protect against tourniquet-induced ischemia-reperfusion injury in patients undergoing knee arthroplasty,but lidocaine is more effective.