利多卡因对老年肺癌根治术患者围术期脑氧代谢及术后早期认知功能影响

目的探讨利多卡因对老年肺癌根治术患者围术期脑氧代谢及术后早期认知功能的影响。方法选取择期拟在全身麻醉下行肺癌根治术的患者80例为研究对象,采用随机数字表法,将患者随机分为利多卡因组(L组)和生理盐水对照组(C组),每组40例。L组于麻醉诱导前静脉注射利多卡因1 mg/kg,随后以1 mg/(kg·h)的速度输注,于手术结束前5 min停止输注。C组以同样方法静脉输注等容量生理盐水。分别于麻醉诱导前(T_0)、利多卡因给药后30 min(T_1)、2 h(T_2)及手术结束时(T_3)经桡动脉和颈内静脉球部采集血样行血气分析,计算动脉-颈内静脉血氧含量差(Da-jvO_2)和脑氧摄取率(CERO_2)。分别于术前1 d及术后1、3、7 d时测定患者血清S100钙结合蛋白(S-100β蛋白)浓度,并采用简易精神状态检查量表(MMSE)对患者进行认知功能评定。结果与T_0时相比,T_1~T_3时两组患者Da-jvO_2及CERO_2均降低(P<0.05)。与C组相比,L组T_2~T_3时Da-jvO_2及CERO_2降低(P<0.05)。与术前1 d时比较,C组术后1、3、7 d时血清S-100β蛋白浓度升高,MMSE评分降低;L组术后1、3 d时血清S-100β蛋白浓度升高,MMSE评分降低(P<0.05)。与C组比较,L组术后1、3 d时血清S-100β蛋白浓度降低,MMSE评分升高(P<0.05),术后7 d时差异无统计学意义(P>0.05)。结论老年肺癌根治术患者静脉应用利多卡因可降低患者围术期脑氧代谢,改善患者术后早期认知功能。

Effects of lidocaine on perioperative cerebral oxygen metabolism and postoperative cognitive in elderly patients undergoing radical for lung cancer

Objective To investigate the effects of lidocaine on perioperative cerebral oxygen metabolism and postoperative cognitive in elderly patients undergoing radical for lung cancer. Methods Eighty patients undergoing radical for lung cancer were randomly di-vided into 2 groups( n=40 each):lidocaine group( Group L) and control group( Group C) . Lidocaine 1 mg/kg was infused before an-esthesia induction,and then was infused at a rate of 1 mg/( kg·h) until 5 minutes before the end of operation in Group L. Group C re-ceived the equal volume of normal saline. Blood samples were taken from the radial artery and jugular bulb for blood gas analyses at the time before induction of anesthesia(T0),at 30 minutes(T1)and 2 hours(T2)after lidocaine treatment and at the end of operative(T3). Cerebral A-VO2 content differences( Da-jvO2 ) and cerebral O2 extraction rate( CERO2 ) were calculated at the same time. Blood col-lection to test serum S100βat the time of 1 day preoperative,1 day,3 days and 7 days after operative,and the mini-mental state exami-nation ( MMSE) score was recorded at the same time. Results Compared with T0 ,the Da-jvO2 and CERO2 were decreased at T1-T3 in both groups(P<0. 05). Compared with group C,the Da-jvO2 and CERO2 were decreased at T2-T3 in Group L(P<0. 05). Compared with the time of 1 day preoperative,the serum S100βwas increased,and the MMSE score was decreased at 1 day,3 days and 7 days af-ter operative in Groups C,and the serum S100β was increased,the MMSE score was decreased at 1 day and 3 days after operative in Group L(P<0. 05). Compared with Group C,the serum S100βwas decreased,and the MMSE score was increased at 1 day and 3 days after operative between the Groups L(P<0. 05),but there was no significant difference at the time of 7 days after operative in two groups(P>0. 05). Conclusion Lidocaine can decrease the cerebral oxygen metabolism during perioperative period,which can im-prove postoperative cognitive in elderly patients undergoing radical for lung cancer.