利多卡因减轻高潮气量通气时可溶性E-选择素的表达

【 目的 检测不同通气情况下血浆髓过氧化物酶（MPO）及可溶性E-选择素（sE-选择素）的表达，探讨利多卡因在呼吸机所致肺损伤（VILI）中的保护作用。 方法 30~60岁腹部手术患者30例，心功能Ⅰ级，ASA Ⅰ级，随机分为3组：低潮气量机械通气组（Ⅰ组，VT=8 ml/kg），高潮气量机械通气组（Ⅱ组，VT=12 ml/kg），利多卡因+高潮气量机械通气组（Ⅲ组，VT=12 ml/kg），每组10例。Ⅲ组于麻醉前静脉注射利多卡因2 mg/kg。监测麻醉前、麻醉开始后3 h呼气末二氧化碳分压（PETCO2）、血氧饱和度（SPO2）、心率（HR）、平均动脉压（MAP）、血浆MPO和sE-选择素的变化。 结果 3组麻醉前后SPO2,HR和MAP无明显改变，麻醉后3 hⅠ组PETCO2高于Ⅱ组和Ⅲ组（P<0.05）；Ⅰ组麻醉后3 h血浆MPO和sE-选择素与麻醉前无显著差异（P>0.05），Ⅱ组麻醉后3 h与麻醉前、Ⅰ组比较，血浆MPO和sE-选择素表达均明显增高（P<0.05），Ⅲ组麻醉后3 h血浆MPO和sE-选择素表达与麻醉前、Ⅰ组比较均无显著差异（P>0.05）。 结论 高潮气量通气可使血浆MPO和sE-选择素表达增高，从而在一定程度上促使VILI的发生和发展，利多卡因具有保护作用。【关键词】 髓过氧化物酶 E-选择素 利多卡因 肺损伤 机械通气

Lidocaine reduces the expression of soluble E-selectin in high-tide mechanical ventilation

【Abstract】 Objective To measure the expression of MPO and soluble E-selectin in sera in different ventilations and to investigate the effects of lidocaine on ventilator-induced lung injury(VILI). Methods 30 cases were divided into three groups:the low-tide ventilation group(VT=8ml/kg), the high-tide ventilation group(VT=12ml/kg）and lidocaine with high-tide ventilation group（VT=12ml/kg）. 2mg/kg lidocaine was applied by venous injection before anesthesia in lidocaine with high-tide ventilation group. End-expiratory carbon dioxide pressure（PETCO2）, oxygen saturation of blood（SPO2）,heart rate（HR）,average arterial pressure（MAP）,MPO and soluble E-selectin in sera were monitored. Results SPO2, HR and MAP were similar in three groups before and after mechanical ventilation. PETCO2 in the low-tide ventilation group was higher than the other two groups after three hour of ventilation.High-tide ventilation expressed much more MPO and soluble E-selectin in sera than low-tide ventilation,but lidocaine reduced the expression of MPO and soluble E-selectin in sera during high-tide ventilation. Conclusions High-tide ventilation increases the expression of MPO and sE-selectin in sera. Lidocaine defends the lung from ventilator-induced injury.