静脉输注利多卡因对心脏外科手术患者围术期心房颤动发生的影响

目的探讨利多卡因静脉输注对心脏外科手术患者围术期心房颤动(房颤)发生的影响。方法择期行心脏手术的患者1,408例,采用数字表法随机分为利多卡因组(L组)和对照组(C组)。L组静脉注射利多卡因,包括负荷量、3 h维持量和21 h维持量三个阶段。C组静脉注射0.9%氯化钠溶液。记录术中、术后7 d内房颤的发生、持续时间及二次房颤发生情况。结果与C组比较,L组患者术中和术后新发房颤发生率均降低(P=0.001,P<0.001);房颤持续时间明显缩短(P<0.001);二次房颤发生率存在降低趋势(P=0.083);术后拔管时间缩短(P<0.001),ICU停留时间缩短(P<0.001),术后住院时间缩短(P<0.001),总费用降低(P=0.045)。结论输注利多卡因可降低房颤发生,缩短房颤持续时间,可能降低二次房颤的发生率缩短术后拔管和ICU停留及术后住院时间,降低总住院费用。

Objective To explore the effects of intravenous lidocaine infusion on perioperative atrial fibrillation(AF)in patients undergoing cardiac surgery.Methods 1408 patients who scheduled for cardiac surgery under cardiopulmonary bypass,were randomized and assigned into two groups:the lidocaine group(Group L,n=704)and the control group(Group C,n=704).Patients in Group L received intravenous lidocaine,including three stages:loading,3 h maintenance and 21 h maintenance.Patients in Group C received intravenous saline infusion replacing lidocaine.Onset timing,lasting time and reoccurrence of new-onset AF was recorded during and in 7 days after surgery.Results Comparing to group C,the incidences of both intraoperative and postoperative new-onset AF in group L were lower significantly(P=0.001,P<0.001),lasting time of AF was shorter significantly(P<0.001),and reoccurrence rate of AF trended to decrease(P=0.083).Comparing to group C,extubation time in group L was shorter significantly(P<0.001),ICU stay duration was shorter significantly(P<0.001),the length of hospital stay was shorter significantly(P<0.001),and total cost for medical care decreased significantly(P=0.045).Conclusion Perioperative lidocaine infusion might decrease the incidence of perioperative new-onset AF,shorten the lasting time of AF,and may decrease the rate of AF reoccurrence after surgery.On the other hand,perioperative intravenous lidocaine could shorten extubation time after surgery,ICU stay duration and length of hospital stay,and decrease total cost for medical care.