利多卡因对心脏外科手术患者术后心房颤动和IL-6、IL-10的影响

Effect of intravenous lidocaine on postoperative atrial fibrillation, IL-6 and IL-10 in patients undergoing cardiac surgery

  • 摘要: 目的探讨利多卡因对心脏外科手术患者术后心房颤动和IL-6、IL-10的影响。方法选取择期行体外循环下心脏外科手术患者60例随机分为2组, 利多卡因组(30例)和对照组(30例)。利多卡因组采用三阶段静脉注射利多卡因:负荷量(1.5 mg/kg持续输注5 min)、3 h维持量2.3 mg /(kg·h)和21 h维持量0.8 mg /(kg·h)。对照组采用生理盐水替代利多卡因静脉输注。术前、手术结束时和术后24 h抽取静脉血液检测血浆IL-6、IL-10的浓度。记录患者术后心房颤动的发生情况。结果与术前比较, 2组患者血浆IL-6和IL-10在手术结束时和术后24 h均明显增加(P均< 0.01)。与对照组比较, 利多卡因组手术结束时和术后24 h血浆IL-6和IL-10降低(P < 0.05或P < 0.01), 术后拔管时间缩短(12.2±4.7) h vs. (15.9±3.6) h, P < 0.01。与对照组比较, 利多卡因组术后心房颤动发生率有减少趋势(10% vs. 24%), 但差异无统计学意义(P > 0.05)。结论静脉输注利多卡因可降低患者心脏术后血浆炎性因子IL-6和IL-10水平, 缩短气管拔管时间和降低术后心房颤动发生的趋势。

     

    Abstract: Objective To investigate the effect of intravenous lidocaine on postoperative atrial fibrillation, IL-6 and IL-10 levels in patients undergoing cardiac surgery. Methods Sixty patients scheduled for cardiac surgery requiring cardiopulmonary bypass, were randomly divided into two groups based on computer-generated randomized assignments: lidocaine group (Group L, n = 30) and control group (Group C, n = 30). Patients in Group L received three-phase intravenous lidocaine infusion regimen as follows: upon induction of general anesthesia, a bolus of intravenous lidocaine 1.5 mg/kg was given over a minimum of 5 min; subsequently, lidocaine 2.3 mg/(kg·h) was infused for the first 3 h; lidocaine was then reduced to 0.8 mg/(kg·h) and discontinued 24 h postoperatively. Patients in Group C received intravenous saline infusion. The bolus amounts and infusion rates were identical to those in Group L. Blood samples were collected before, at the end of surgery and 24 h after surgery for measurement of IL-6 and IL-10 levels. The episode of new onset of atrial fibrillation and the development of cardiovascular events after surgery were recorded. Results Compared with preoperative levels, serum IL-6 and IL-10 levels at the end of surgery and 24 h after surgery were significantly higher (all P < 0.01). Compared with Group C, serum IL-6 and IL-10 levels at the end of surgery and 24 h after surgery were significantly lower in Group L (P < 0.05 or P < 0.01). In Group C, postoperative extubation time was (15.9±3.6) h, significantly longer than (12.2±4.7) h in Group L (P < 0.01). Compared with Group C, the incidence of postoperative atrial fibrillation tended to decline in Group L(10% vs. 24%, P > 0.05). Conclusions Perioperative intravenous infusion of lidocaine could decrease postoperative serum IL-6 and IL-10 levels, shorten tracheal extubation time and lower the risk of postoperative atrial fibrillation.

     

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