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利多卡因预处理对膝关节镜手术中止血带引起的脂质过氧化的影响
Effects of lidocaine preconditioning on tourniquet-induced lipid peroxidation in arthroscopic knee surgery
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DOI:
作者:
李琪,张俊峰
LI Qi, ZHANG Junfeng
作者单位:
上海市第六人民医院麻醉科
Department of Anesthesiology, Shanghai 6th People’s Hospital,Shanghai Jiaotong University, Shanghai 200233, China
关键词:
利多卡因;脂质过氧化;缺血再灌注;止血带
Lidocaine; Lipid peroxidation; Ischemia-reperfusion injury; Tourniquet
摘要:
【摘要】目的 探讨利多卡因预处理对膝关节镜手术患者止血带诱发脂质过氧化的影响。方法 择期膝关节镜手术患者38例,年龄18-65岁,ASA I-II级。随机分为对照组(C组)和利多卡因预处理组(L组),每组19例。于止血带充气前5分钟,L组给予利多卡因首剂1.5mg/kg之后持续静脉输注2 mg﹒kg-1﹒h-1利多卡因1小时,而C组持续输注等容生理盐水。于麻醉前(基础值,B)、止血带放气后10min(T1)、20 min(T2)时采集肘静脉血样,测定血清丙二醛(MDA)的浓度、乳酸脱氢酶(LDH)和超氧化物歧化酶(SOD)活性,随访术后1h,术后24h疼痛视觉模拟评分(VAS)。 结果C组T1,T2时间点的血清MDA浓度([3.82±0.53] nmol/ml,[4.08±0.72] nmol/ml)均高于B时间点的基础值([2.88±0.46] nmol/ml)(P
O.05)。在T1,T2时间点,L组MDA, LDH,SOD均低于C组(P
O.05),术后24h VAS评分L组(2.20±1.19)低于C组(3.46±0.78)(P
【Abstract】Objective To investigate the effects of intravenous lidocaine preconditioning on lipid peroxidation due to tourniquet application during lower-extremity surgery. Methods Thirty-eight patients of American Society of Anesthesiologist physical status I - II undergoing elective arthroscopic knee surgery were randomly assigned to two groups: control group (group C, n=19) and lidocaine group (group L, n=19). Regional nerve block plus laryngeal mask anesthesia were performed in both groups. Group L received IV lidocaine (bolus 1.5 mg/kg, then infusion 2 mg﹒kg-1﹒h-1 for 1 hr) 5 minutes before the tourniquet was roped, whereas group C received isovolume saline. The upper extremity vein blood was drawn before anesthesia (Baseline, B), at 10 minutes (T1)and 20 minutes(T2) after tourniquet release for the measurements of malondialdehyde(MDA), lactate dehydrogenase(LDH), and superoxide dismutase(SOD). Postoperative pain was assessed with visual analogue scale (VAS) score 1h and 24h postoperatively. Results In group C, the levels of serum MDA were significantly increased at T1 and T2 ([3.82±0.53] nmol/ml, [4.08±0.72] nmol/ml) than that at B([2.88±0.46] nmol/ml) (P< 0.05), the levels of LDH at T1 and T2([110.61±23.26] U/L,[113.22±24.59] U/L)were significantly higher than those at B([80.42±27.03] U/L) (P< 0.05), the levels of SOD at T1 and T2([130.02±8.76] nU/ml,[132.29±8.75] nU/ml)were significantly higher than those at B([113.37±9.12] nU/ml) (P< 0.05). In group L, MDA concentration was significantly less at T1 and T2([2.85±0.44] nmol/ml,[2.67±0.46] nmol/ml)than the baseline([3.04±0.56] nmol/ml)(P < 0.05) .There were no significant change in LDH and SOD activity after tourniquet release compared with the baseline. MDA, LDH and SOD levels in group L were significantly lower than those in group C at T1 and T2(all P < 0.05). There was no difference between group L and group C in VAS scores 1h postoperatively (P < 0.05), but VAS scores were lower in group L than those in group C 24h postoperatively(P < 0.05). Conclusion Precondition with lidocaine can attenuate lipid peroxidation induced by tourniquet application, thus it can reduce ischemia-reperfusion injury, and relieve postoperative pain.
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