雾化吸入利多卡因对老年髋部骨折手术患者的肺保护作用

Pulmonary protective effect of nebulized inhalation of lidocaine on elderly patients undergoing hip fracture surgery

目的探讨雾化吸入利多卡因(NL)对老年髋部骨折手术患者的肺保护作用。方法前瞻性选取2020年9月至2021年12月于惠州市第六人民医院行髋部骨折手术的老年患者80例,按随机数字表法分成NL组和对照组各40例。麻醉开始前30 min内,NL组给予2%利多卡因10 ml氧气驱动雾化吸入,对照组雾化吸入等容量无菌注射用水。所有患者均采用喉罩插管全麻+髂筋膜间隙阻滞。采用随机、双盲、对照方法进行临床研究。对比两组患者术中的气道峰压(P_(peak))平均值、气道平台压(P_(plat))平均值和肺动态顺应性(C_(dyn))平均值;对比两组患者之间以及术前和术后动脉血二氧化碳分压(PaCO_(2))、肺泡-动脉氧分压差(A-aDO_(2))、呼吸指数(RI)和氧合指数(OI)的变化情况;对比两组患者术前1 d、术后第2天和第7天的临床肺部感染评分(CPIS)和肺部超声评分(LUS)。结果两组术中P_(peak)平均值、P_(plat)平均值和C_(dyn)平均值比较差异均无统计学意义(均P>0.05)。两组术后A-aDO_(2)、RI较术前均升高,OI较术前均降低(均P<0.05);术后NL组A-aDO_(2)和RI低于对照组,OI高于对照组(均P<0.05);两组术前和术后的PaCO_(2)比较差异无统计学意义(均P>0.05)。与术前1 d相比,术后第2天和第7天两组CPIS和LUS均明显升高(均P<0.05);与术后第2天相比,术后第7天两组患者CPIS和LUS明显降低(均P<0.05);术后第2天,NL组CPIS和LUS明显低于对照组(均P<0.05);术后第7天,NL组LUS明显低于对照组(P<0.05),两组CPIS评分差异无统计学意义(P>0.05)。结论雾化吸入利多卡因能够降低老年髋部骨折手术患者的肺功能损害,具有一定的肺保护作用。

Objective To explore the lung protective effect of nebulized inhalation of lidocaine(NL)on elderly patients undergoing hip fracture surgery.Methods A prospective study was conducted on 80 elderly patients who underwent hip fracture surgery at the Huizhou Sixth People′s Hospital from September 2020 to December 2021.They were randomly divided into an NL group and a control group with 40 patients in each group.Within 30 minutes before the start of anesthesia,the NL group was given 2%lidocaine 10 ml oxygen driven nebulization inhalation,while the control group was given equal volume sterile injection water nebulization inhalation.All patients underwent general anesthesia with laryngeal mask intubation and iliac fascia space block.A randomized,double-blind,and controlled clinical study was conducted.The average values of intraoperative peak airway pressure(P_(peak)),plateau airway pressure(P_(plat)),and lung dynamic compliance(C_(dyn))were compared between two groups of patients;We compared the changes in arterial partial pressure of CO_(2)(PaCO_(2)),alveolar arterial oxygen differential pressure(A-aDO_(2)),respiratory index(RI),and oxygen index(OI)between the two groups of patients and before and after surgery;The clinical pulmonary infection score(CPIS)and lung ultrasound score(LUS)were also compared between two groups of patients on the first day before surgery,the second day after surgery,and the seventh day after surgery.Resultsl There was no statistically significant difference in the average values of P_(peak),P_(plat),and C_(dyn)between the two groups during surgery(all P>0.05).After surgery,A-aDO_(2)and RI in both groups increased compared to before surgery,while OI decreased compared to before surgery(all P<0.05);After surgery,A-aDO_(2)and RI in the NL group decreased compared to the control group,while OI increased compared to the control group(all P<0.05);There was no statistically significant difference in PaCO_(2)between the two groups before and after skin incision(all P>0.05).Compared with the 1st day before surgery,the CPIS and LUS in both groups were significantly increased on the 2nd and 7th day after surgery(all P<0.05);Compared with the second day after surgery,the CPIS and LUS of both groups of patients were significantly reduced on the seventh day after surgery(all P<0.05);On the second day after surgery,the CPIS and LUS in the NL group were significantly lower than those in the control group(all P<0.05);On the 7th day after surgery,the LUS of the NL group was significantly lower than that of the control group(P<0.05);There was no statistically significant difference in CPIS scores between the two groups(P>0.05).Conclusions Nebulized inhalation of lidocaine can reduce lung function damage in elderly patients undergoing hip fracture surgery,and has a certain lung protective effect.