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利多卡因静脉持续输注对老年患者非心脏手术中心肌损伤标志物的影响
Impact of introvenous lidocaine on myocardial injury marker level during non-cardio surgery in the enderly
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DOI:
作者:
王海滨1 俞颖2 李浪平2 罗艳3 沈亮2
Haibin Wang1, Ying Yu2, Langping Li2, Yan Luo3 , Liang Shen2*
作者单位:
1. 201800,上海交通大学医学院附属瑞金医院北院麻醉科 2. 200025,上海交通大学医学院附属瑞金医院卢湾分院麻醉科 3. 200025,上海交通大学医学院附属瑞金医院麻醉科
1Department of Anaesthesiology, Ruijin Hospita North, Shanghai Jiaotong University College of Medicine, Shanghai 2Department of Anaesthesiology, Luwani Brunch, Ruijin Hospital, Shanghai Jiaotong University College of Medicine, Shanghai 3Department of Anaesthesiology, Ruijin Hospital, Shanghai Jiaotong University College of Medicine, Shanghai
关键词:
利多卡因;肌红蛋白;N-末端脑钠素前体;胃肠道手术
Lodcaine; myoglobin(Myo); N-terminal pro brain natriuretic peptide (NT-proBNP) ; gastrointestinal surgery
摘要:
目的 利多卡因是经典的抗心律失常药,既往研究发现利多卡因在心脏手术中具有心肌保护作用,本研究探讨利多卡因静脉持续输注对老年患者胃肠手术中心肌损害的影响。 方法 选择行非心脏择期(胃肠道)手术的老年(>60岁)患者80例,随机分为利多卡因组(n=40,Group LIDO),术中利多卡因(1.5mg/Kg/h)静脉泵注;对照组(n=40,Group Contral), 术中生理盐水(1.5mg/Kg/h)静脉泵注。分别检测手术前、手术结束时和术后第1天、术后第2天外周血中肌红蛋白(Myo)和N-末端脑钠素前体(NT-proBNP)的浓度,并观察比较手术后并发症。 结果 与术前相比较,手术结束时及术后第1天两组的Myo以及NT-proBNP明显升高,差异具有统计学意义;与对照组相比,手术结束时及术后第1天利多卡因组中的Myo浓度明显下降(P<0.01);该时间点利多卡因组的NT-proBNP较对照组明显下降,差异具有统计学意义(P<0.01)。而其他临床变化包括ICU停留时间、术后住院天数等两组之间均无明显差异(P>0.05)。 结论:术中持续输注利多卡因(1.5mg/Kg/h)可以降低胃肠手术老年患者术后心肌损伤标志物的水平。
Objective: Lidocaine is a kind of classic antiarrlythmic drug and has been demonstrated to exert cardio protection in patients undergoing cardio-surgery. We studied the effect of lidocaine infusion during gastrointestinal surgery in the elderly. Methods: 80 aged patients (>60 y) undergoing non-cardio surgery (gastrointestinal surgery) were enrolled. The lidocaine group (n=40, Group LIDO) received an infusion of lidocaine 1.5mg/Kg/h; the control group (n=40, Group Control) received an infusion of normal saline(NS) 1.5mg/Kg/h. We measured serum concentration of myoglobin(Myo) and N-terminal pro brain natriuretic peptide (NT-proBNP) before and immediately after the surgery, postoperative day (POD#1) and (POD#2). The complication rate and clinical outcomes were compared. Results: Compared with preoperation, the concentrations of Myo and NT-proBNP in both groups were increased at the end of operation and POD#1. The concentration of Myo was significantly lower in the Group LIDO compared to the Group Control at the end of the operation and POD#1. The concentration of NT-proBNP was significantly lower in the Group LIDO than the Group Control at the end of the operation and POD#1. However, clinical variables including ICU-stay and postoperative hospital stay were not different. Conclusion: Lidocaine infused at 1.5mg/Kg/h reduced postoperative myocardical injury marker levels in elderly patients undergoing gastrointestinal surgery.
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