静脉输注利多卡因对单肺通气患者肺内分流和炎症反应的影响

The effect of intravenous injection of lidocaine on intrapulmonary shunt and inflammation in patients with one‑lung ventilation

目的探索术中静脉输注利多卡因对单肺通气(one⁃lung ventilation,OLV)患者肺内分流和炎症反应的影响。方法择期全身麻醉下行胸腔镜肺部手术的患者60例,按随机数字表法分为利多卡因组(L组)和对照组(C组),每组30例。在两组其他麻醉用药相同的基础上,L组静脉输注利多卡因1.5 mg/kg,随后持续静脉输注1.5 mg·kg^(−1)·h^(−1),C组以等量生理盐水替换利多卡因。记录两组患者一般资料及术中情况,记录两组患者插管前、插管后1 min、拔管即刻的心率和MAP,记录两组患者双肺通气时(T_(0))、OLV 15 min(T_(1))、OLV 30 min(T_(2))时的心率、MAP、Hb、PaO_(2)、PaCO_(2)并计算肺内分流率,记录两组患者T_(0)、术毕(T_(3))时血清IL⁃6、IL⁃8、TNF⁃α水平。结果与插管前比较,两组患者插管后1 min和拔管即刻的MAP、心率均升高(P<0.05);与C组比较,L组插管后1 min、拔管即刻的MAP和心率均降低(P<0.05)。与T_(0)比较,两组患者T_(3)时IL⁃6、IL⁃8、TNF⁃α水平均升高(P<0.05);与C组比较,L组T_(3)时IL⁃6、IL⁃8、TNF⁃α水平均降低(P<0.05)。两组患者各时点PaO_(2)、PaCO_(2)、肺内分流率、Hb、MAP、心率比较,差异均无统计学意义(P>0.05);与T_(0)比较,两组患者T_(1)、T_(2)时肺内分流率均增加、PaO_(2)均降低(P<0.05)。结论静脉输注利多卡因能有效抑制双腔支气管插管和拔管时应激反应,减少术中炎症因子释放,对行OLV患者肺内分流无明显影响。

Objective To explore the effects of intravenous lidocaine infusion on intrapulmonary shunt and inflammatory re⁃sponse in patients with one⁃lung ventilation(OLV)undergoing thoracoscopic surgery.Methods According to random number table method,sixty patients who underwent thoracoscopic pulmonary surgery under elective general anesthesia were divided into the lidocaine group(group L)and the control group(group C),with 30 cases in each group.While other anesthetics used in patients of the two groups are all the same,the patients in group L received lidocaine 1.5 mg/kg intravenously,followed by a continuous infusion of 1.5 mg·kg^(−1)·h^(−1),and group C received an intravenous injection of the same amount of normal saline.Records of two groups of patients with general infor⁃mation and intraoperative situation.Heart rate,mean artery pressure(MAP)before tracheal intubation,1 min after intubation,and imme⁃diately after extubation of patients in two groups were recorded.Heart rate,MAP,hemoglobin(Hb),partial pressure of oxygen(PaO_(2)),and the pressure of carbon dioxide(PaCO_(2))of patients were recorded at the time of two⁃lung ventilation(T_(0)),15 min of OLV(T_(1)),30 min of OLV(T_(2)),and the intrapulmonary shunt rate was calculated.Serum interleukin(IL)⁃6,IL⁃8,tumor necrosis factor⁃α(TNF⁃α)levels were detected at T_(0) and the end of surgery(T_(3)).Results Compared with before tracheal intubation,the MAP and heart rate of patients in the two groups increased 1 min after intubation and immediately after extubation(P<0.05).The MAP and heart rate of group L are low⁃er at 1 min after intubation and immediately after extubation than the parameters in group C(P<0.05).Compared with T_(0),the levels of IL⁃6,IL⁃8 and TNF⁃αin the two groups were increased at T_(3)(P<0.05).The levels of IL⁃6,IL⁃8 and TNF⁃αin group L were lower at T_(3) than the levels of the group C(P<0.05).There was no significant difference in PaO_(2),PaCO_(2),intrapulmonary shunt rate,Hb,MAP and heart rate between the two groups at each time point(P>0.05).Compared with T_(0),the intrapulmonary shunt rate increased,and PaO_(2)de⁃creased at T_(1) and T_(2) in both groups(P<0.05).Conclusions Intravenous infusion of lidocaine can effectively inhibit the stress re⁃sponse during double⁃lumen bronchial intubation and extubation,reduce the release of inflammatory factors during surgery,and has no significant effect on intrapulmonary shunt in patients with OLV.