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利多卡因雾化吸入对单肺通气患者围术期肺功能、炎症因子及相关并发症的影响
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| 篇名： | 利多卡因雾化吸入对单肺通气患者围术期肺功能、炎症因子及相关并发症的影响 |
| TITLE： | Effects of Lidocaine Aerosol Inhalation on Perioperative Pulmonary Function ，Inflammatory Factors and Related Complication of Patients with One-lung Ventilation |
| 摘要： | 目的：探讨利多卡因雾化吸入对单肺通气患者围术期肺功能、炎症因子及相关并发症的影响。方法：将2018年1月－2020年5月攀枝花学院附属医院收治的拟择期于全身麻醉单肺通气下行肺部分切除术的120例患者按随机数字表法分为利多卡因雾化吸入组（L组）和无菌水雾化吸入组（N组），每组60例。两组患者均以静脉注射咪达唑仑注射液0.1mg/kg+丙泊酚乳状注射液2.0mg/kg+枸橼酸舒芬太尼注射液0.4μg/kg行麻醉诱导；于插入双管气管插管后，L组患者雾化吸入盐酸利多卡因注射液1.5mg/kg加无菌水稀释至20mL，N组患者雾化吸入无菌水20mL，吸入流量均为2L/min。两组患者均静脉持续泵注丙泊酚乳状注射液4～12mg/（kg·h）+注射用盐酸瑞芬太尼0.2～1μg（/kg·min）+注射用苯磺顺阿曲库铵0.05～0.1mg/（kg·h）行麻醉维持。术后8h，L组患者再次雾化吸入盐酸利多卡因注射液1.5mg/kg加无菌水稀释至20mL，N组患者再次雾化吸入无菌水20mL。观察两组患者麻醉开始前（T1）、单肺通气60min（T2）、拔管后12h（T3）时的血气分析指标[动脉血氧分压（PaO2）、二氧化碳分压（PaCO2）、乳酸（Lac）、氧合指数（P/F）]、血清炎症因子[白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）及核因子κB（NF-κB）]水平，麻醉开始5min（t1）、T2、手术结束后15min（t3）时的呼吸及循环参数指标[血管外肺水（EVLW）、肺血管通透性指数（PVPI）、心率（HR）、每搏量（SV）]，记录两组患者的拔管时间、拔管后12h疼痛视觉模拟量表（VAS）评分、术后下床时间和拔管后12h咽喉疼痛发生率以及不良反应发生情况。结果：两组患者T1或t1时的血气分析指标、血清炎症因子水平、呼吸及循环参数指标比较，差异均无统计学意义（P＞0.05）。两组患者T2、T3时的PaO2、PaCO2、Lac、IL-6、TNF-α、NF-κB水平均显著高于同组T1时，P/F均显著低于同组T1时，而L组PaCO2、Lac、IL-6、TNF-α、NF-κB水平均显著低于同期N组，PaO2、P/F均显著高于同期N组（P＜0.05）。两组患者T2、t3时的EVLW、PVPI和L组的SV、N组的HR均显著高于同组t1时，L组的HR、N组的SV均显著低于同组t1时，而L组EVLW、PVPI、HR显著低于同期N组，SV显著高于同期N组（P＜0.05）。L组患者拔管时间、拔管后12hVAS评分、术后下床时间、拔管后12h咽喉疼痛发生率均显著短于或低于N组（P＜0.05），且苏醒期间未见明显或严重的不良反应发生。结论：利多卡因雾化吸入可有效改善单肺通气患者的通气及氧合功能，抑制机体炎症因子释放，减少咽喉疼痛等术后相关并发症的发生，安全性较好。 |
| ABSTRACT： | OBJECTIVE：To investigate the effects of lidocaine aerosol inhalation on perioperative pulmonary function ， inflammation factor and related complications of patients with one-lung ventilation. METHODS ：A total of 120 patients who were admitted to the Affiliated Hospital of Panzhihua University from January 2018 to May 2020 and planned to undergo partial pneumonectomy under general anesthesia and one-lung ventilation were selected. According to random number table method ，they were divided into lidocaine aerosol inhalation group （group L ）and sterile water aerosol inhalation group （group N ），with 60 cases in each group. Two groups were given Midazolam injection 0.1 mg/kg+Propofol injectable emulsion 2.0 mg/kg+Sufentanil citrate injection 0.4 μg/kg to induce anesthesia. After the insertion of the double-lumen tracheal tube ，group L was given aerosol inhalation of Lidocaine hydrochloride injection 1.5 mg/kg diluted to 20 mL with sterile water ；group N was given aerosol inhalation of sterile water 20 mL at the flow rate of 2 L/min. Patients in both groups were continuously pumped with Propofol injectable emulsion 4-12 mg/（kg·h）+Remifentanil hydrochloride for injection 0.2-1 μg（/ kg·min）+Cisatracurium besilate for injection 0.05-0.1 mg/（kg·h）for anesthesia maintenance. Eight hours after operation ，group L inhaled of Lidocaine hydrochloride injection 1.5 mg/kg diluted to 20 mL with sterile water again ，and group N inhaled of sterile water 20 mL again. Arterial blood gas analysis indexes [arterial partial pressure of oxygen （PaO2），partial pressure of carbon dioxide （PaCO2），lactic acid （Lac），oxygenation index （P/F）]，serum inflammatory factors [interleukin 6 （IL-6），tumor necrosis factor α（TNF-α）and nuclear factor κB（NF-κB）] were observed in 2 groups before anesthesia（T1），60 min of one-lung ventilation （T2），and 12 h after extubation （T3）. Respiratory and circulatory parameters [extravascular lung water（EVLW），pulmonary vascular permeability index （PVPI），heart rate （HR），stroke volume （SV）] were also observed 5 min after anesthesia （t1），T2 and 15 min after surgery （t3）. Extubation time ，visual analogue scale （VAS） score of 12 h after extubation，time of getting out of bed ，the incidence of throat pain of 12 h after extubation and the occurrence of ADR were recorded in 2 groups. RESULTS ：There was no significant difference in arterial blood gas analysis indexes ，serum inflammatory factor levels ，respiratory and circulatory parameters between the two groups at T 1 or t 1（P＞0.05）. The levels of PaO 2，PaCO2， Lac，IL-6，TNF-α and NF-κB in 2 groups at T 2 and T 3 were significantly higher than at T 1，P/F at T 2 and T 3 was significantly lower than at T 1；in group L ，the levels of PaCO 2，Lac，IL-6，TNF-α，NF-κB were significantly lower than group N，and PaO 2 and P/F were significantly higher than group N （P＜0.05）. EVLW and PVPI of 2 groups at T 2and t 3，SV of group L ，HR of group N were significantly higher than corresponding group at T 1，while EVLW ，PVPI and HR of group L were significantly lower than group N，SV was significantly higher than group N at corresponding period （P＜0.05）. The extubation time ，VAS score of 12 h after extubation，time to get out of bed after surgery ，the incidence of throat pain of 12 h after extubation in group L were significantly shorter or lower than group N （P＜0.05）. No obvious and serious ADR occurred during recovery. CONCLUSIONS：Lidocaine aerosol inhalation can effectively improve ventilation and oxygenation function of patients undergoing one-lung ventilation ，inhibit the release of inflammatory factors ，and reduce the incidence of postoperative complications with good safety. |
| 期刊： | 2021年第32卷第18期 |
| 作者： | 陶广华，吴勇，葛华顺，于布为 |
| AUTHORS： | TAO Guanghua ，WU Yong，GE Huashun ，YU Buwei |
| 关键字： | 利多卡因；雾化吸入；单肺通气；围术期；肺功能；炎症因子；并发症 |
| KEYWORDS： | Lidocaine；Aerosol inhalation ；One-lung ventilation ；Postoperative period ；Pulmonary function ；Inflammatory |
| 阅读数： | 271 次 |
| 本月下载数： | 1 次 |
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