«上一篇/Previous Article|本期目录/Table of Contents|下一篇/Next Article»

《中华肺部疾病杂志》[ISSN:1006-6977/CN:61-1281/TN]

卷:

期数:

2020年04期

页码:

488-492

栏目:

论著

出版日期:

2020-08-20

文章信息/Info

Title:

Effects of intravenous pumping of lidocaine combined with dexmedetomidine on lung function and immune function of patients undergoing thoracoscopic surgery

作者:

朱 宏¹ 邹丽峰¹ 许 军¹ 王晓宇²

221300 江苏,江苏省邳州市人民医院麻醉科¹ 221200 江苏,江苏省徐州市儿童医院胸外科²

Author(s):

Zhu Hong¹;  Zou Lifeng¹;  Xu Jun¹;  Wang Xiaoyu².

¹Department of Anesthesiology, Pizhou People's Hospital, Pizhou 221300, Jiangsu Province, China; ²Department of Thoracic Surgery, Xuzhou Children's Hospital, Xuzhou 221200, Jiangsu Province, China
Corresponding author

关键词:

胸腔镜;  利多卡因;  右美托咪定;  肺功能;  免疫功能

Keywords:

Thoracoscopy;  Lidocaine;  Dexmedetomidine;  Pulmonary function;  Immune function

分类号:

R734.2

DOI:

10.3877/cma.j.issn.1674-6902.2020.04.012

摘要:

目的 探讨静脉泵注利多卡因复合右美托咪定对胸腔镜手术患者肺功能以及免疫功能的影响。方法 选择江苏省邳州市人民医院胸外科2016年7月至2018年7月50例胸腔镜手术患者,ASA Ⅰ～Ⅱ级,其中男31例,女19例,均为单侧肺部病变,且采用支气管内麻醉,分为对照组24例,研究组26例,对照组在麻醉诱导前15 min静脉泵注右美托咪定 0.5 μg/kg,后改为0.25 μg/kg?h持续静脉泵注至关胸,研究组在对照组基础上静脉泵注利多卡因,即麻醉诱导前15 min泵注利多卡因1 mg/kg,后改为1 mg/kg?h持续泵注至关胸。比较两组单肺通气时(T₁)、单肺通气结束(T₂)和返回病房前(T₃)氧合指数(OI)、肺内分流率(S/ T)和呼吸指数(RI),记录两组诱导前(T₄)、术毕(T₅)和术后24 h(T₆)CD4⁺、CD8⁺和CD4⁺/CD8⁺。结果 T₁时,两组OI、S/ T、RI比较差异无统计学意义(P>0.05),T₂、T₃时,研究组OI[(363.48±24.11)mmHg vs.(335.48±31.11)mmHg、(388.84±34.64)mmHg vs.(360.88±38.42)mmHg]高于对照组(P<0.05),S/ T[(14.86±2.58)% vs.(18.33±2.53)%、(12.56±2.28)% vs.(15.57±1.90)%]、RI[(0.82±0.18)vs.(1.07±0.14)、(0.52±0.12)vs(0.78±0.13)]低于对照组(P<0.05)。T₄时,两组CD4⁺、CD8⁺和CD4⁺/CD8⁺比较差异无统计学意义(P>0.05),T₅、T₆时,两组CD8⁺比较差异无统计学意义(P>0.05),研究组CD4⁺[(36.16±7.84)% vs.(29.48±8.10)%、(39.72±8.79)% vs.(32.48±8.87)%]、CD4⁺/CD8⁺[(2.12±0.20)vs.(2.00±0.20)、(2.13±0.19)vs.(2.01±0.17)]高于对照组(P<0.05)。结论 静脉泵注利多卡因复合右美托咪定提高胸腔镜手术患者的氧合指数,降低肺内分流率和呼吸指数,提高CD4⁺、CD4⁺/CD8⁺,改善肺功能及免疫功能。

Abstract:

Objective To investigate the effects of intravenous pumping of lidocaine combined with dexmedetomidine(Dex)on the lung function and immune function of the patients undergoing thoracoscopic surgery. Methods A total of 50 patients(ASA Ⅰ-Ⅱ grade, 31 males and 19 females)undergoing thoracoscopic surgery with unilateral pulmonary lesions and intrabronchial anesthesia in the Department of Thoracic Surgery of Pizhou People's Hospital of Jiangsu Province from July 2016 to July 2018 were selected for this study. The patients were randomly divided into a control group(n=24)and a study group(n=26). In the control group, continuous intravenous pumping of Dex 0.5 μg/kg was given in 15 minutes before anesthesia induction, and then 0.25 μg/kg?h was continuously pumped until the thoracic incision was closed. In the study group, continuous intravenous pumping of lidocaine 1 mg/kg was given in 15 minutes before anesthesia induction, and then lidocaine 1 mg/kg?h was continuously pumped until the thoracic incision was closed. The oxygenation index(OI), intrapulmonary shunt rate(S/ T)and respiratory index(RI)were compared at one-lung ventilation(T₁), at the end of one-lung ventilation(T₂)and before returning to the ward(T₃)between the two groups. CD4⁺, CD8⁺ and CD4⁺/CD8⁺ were recorded before anesthesia induction(T₄), after operation(T₅)and at postoperative 24 hours(T₆)in the two groups. Results No significant difference was found in the OI, S/ T and RI at T₁ between the two groups(P>0.05). At T₂ and T₃, the values of OI in the study group [(363.48±24.11)mmHg and(388.84±34.64)mmHg, respectively] were significantly higher than those of the control group [(335.48±31.11)mmHg and(360.88±38.42)mmHg, respectively, P<0.05], the values of S/ T in the study group [(14.86±2.58)% and(12.56±2.28)%, respectively] were significantly lower than those of the control group [(18.33±2.53)% and(15.57±1.90)%, respectively, P<0.05], and the values of RI in the study group [(0.82±0.18)and(0.52±0.12), respectively] were significantly lower than those of the control group [(1.07±0.14)and(0.78±0.13), respectively, P<0.05]. There was no significant difference in CD4⁺, CD8⁺ and CD4⁺/CD8⁺ at T₄ between the two groups(P>0.05). At T₅ and T₆, there was no significant difference in CD8⁺ between the two groups(P>0.05), however, the values of CD4⁺ in the study group [(36.16±7.84)% and(39.72±8.79)%, respectively] were significantly higher than those of the control group [(29.48±8.10)% and(32.48±8.87)%, respectively, P<0.05], and the values of CD4⁺/CD8⁺ in the study group [(2.12±0.20)and(2.13±0.19), respectively] were significantly higher than those of the control group [(2.00±0.20)and(2.01±0.17), respectively, P<0.05)]. Conclusion Intravenous pumping of lidocaine combined with Dex could increase the OI, decrease the(S/ T)and RI, increase the CD4⁺ and CD4⁺/CD8⁺, and improve the lung function and immune function of the patients undergoing thoracoscopic surgery.

参考文献/References:

1 刘 阳. 肺部微创手术的历史、现状及趋势[J/CD]. 中华肺部疾病杂志(电子版), 2017, 10(4): 385-390.
2 Muller CO, Ali L, Matta R, et al. Thoracoscopy Versus Open Surgery for Persistent Ductus Arteriosus and Vascular Ring Anomaly in Neonates and Infants[J]. J Laparoendosc Adv Surg Tech A, 2018, 28(8): 1008-1011.
3 Liu J, Liao X, Li Y, et al. Effect of low tidal volume with PEEP on respiratory function in infants undergoing one-lung ventilation[J]. Anaesthesist, 2017, 66(9): 667-671.
4 吴 艳, 王秀娟, 康晓艳, 等. 术前康复训练对胸腔镜治疗早期非小细胞肺癌患者心肺功能的影响[J]. 临床肺科杂志, 2018, 23(7): 1217-1221.
5 姚 达, 钱有辉, 万延辉, 等. 联合应用右美托咪定与远隔缺血预处理对胸腔镜肺部手术的肺保护作用及机制研究[J]. 河北医科大学学报, 2017, 38(8): 897-900.
6 Lee SH, Kim N, Lee CY, et al. Effects of dexmedetomidine on oxygenation and lung mechanics in patients with moderate chronic obstructive pulmonary disease undergoing lung cancer surgery: A randomised double-blinded trial[J]. Eur J Anaesthesiol, 2016, 33(4): 275-282.
7 龙 谦, 罗 猛, 许 川, 等. 乌司他丁对老年胸腔镜辅助肺叶切除患者免疫功能及认知功能的影响[J]. 中国老年学杂志, 2018, 38(8): 1877-1880.
8 Boland JW, Pockley AG. Influence of opioids on immune function in patients with cancer pain: from bench to bedside[J]. Br J Pharmacol, 2018, 175(14): 2726-2736.
9 罗梦思, 吴 论. 肺结节手术中非气管插管胸腔镜的麻醉管理[J]. 临床麻醉学杂志, 2018, 34(2): 194-196.
10 邓煜锋, 漆奋强, 卢建华, 等. 保留自主呼吸的非气管插管与双腔气管插管应用于胸腔镜手术的随机对照试验[J]. 中国胸心血管外科临床杂志, 2018, 25(5): 411-415.
11 李诗恩, 胡安民, 张中军. 保留自主呼吸非插管麻醉在胸腔镜手术中的应用进展[J]. 医学综述, 2017, 23(20): 4132-4136.
12 赵子聪, 洪志鹏. 外科胸腔镜的发展现状[J/CD]. 中华肺部疾病杂志(电子版), 2018, 11(5): 618-620.
13 尹 随, 李 樊, 邓 豫, 等. 非气管插管麻醉在胸腔镜肺叶切除术中的应用对比研究[J]. 中国胸心血管外科临床杂志, 2019, 26(1): 57-62.
14 刘 洋, 王 生, 韩庆波, 等. 帕瑞昔布对胸腔镜肺叶切除术患者围术期镇痛效果、氧化应激反应及免疫功能的影响[J]. 临床肺科杂志, 2018, 23(7): 1297-1300.
15 Behmenburg F, Pickert E, Mathes A, et al. The Cardioprotective Effect of Dexmedetomidine in Rats Is Dose-Dependent and Mediated by BKCa Channels[J]. J Cardiovasc Pharmacol, 2017, 69(4): 228-235.
16 罗耀文, 石 伟. 不同剂量右美托咪定在慢性阻塞性肺疾病患者机械通气中的应用及对肺功能的影响[J/CD]. 中华肺部疾病杂志(电子版), 2017, 10(4): 441-444.
17 刘子嘉, 张良燕, 郑旭光, 等. 术中利多卡因持续静脉泵入对胸腔镜肺叶切除术患者阿片类用量及术后恢复的影响[J]. 中国医学科学院学报, 2018, 40(2): 163-169.
18 Beaussier M, Delbos A, Maurice-Szamburski A, et al. Perioperative Use of Intravenous Lidocaine[J]. Drugs, 2018, 78(12): 1229-1246.
19 de Klaver MJ, Buckingham MG, Rich GF. Lidocaine attenuates cytokine-induced cell injury in endothelial and vascular smooth muscle cells[J]. Anesth Analg, 2003, 97(2): 465-470.
20 Cui W, Li Y, Li S, et al. Systemic lidocaine inhibits remifentanil-induced hyperalgesia via the inhibition of cPKCgamma membrane translocation in spinal dorsal horn of rats[J]. J Neurosurg Anesthesiol, 2009, 21(4): 318-325.
21 倪程耀, 陈 新, 吴胜军. 利多卡因对肺缺血再灌注损伤模型大鼠炎症反应因子的影响[J]. 中国药房, 2014, 25(45): 4259-4261.
22 Tolska HK, Takala AJ, Jero J. Peritonsillar infiltration of lidocaine with adrenaline is associated with increased risk of secondary post-tonsillectomy haemorrhage[J]. J Laryngol Otol, 2018, 132(10): 911-922.
23 Saito T, Yamamoto Y, Feng GG, et al. Lidocaine Prevents Oxidative Stress-Induced Endothelial Dysfunction of the Systemic Artery in Rats With Intermittent Periodontal Inflammation[J]. Anesth Analg, 2017, 124(6): 2054-2062.
24 陈 菲, 马 良, 王忠慧. 利多卡因对单肺通气围术期患者氧化应激反应的干预作用[J]. 昆明医科大学学报, 2015, 36(12): 77-79.
25 Aerts L, Selis E, Corbiere V, et al. HBHA-Induced Polycytotoxic CD4⁺ T Lymphocytes Are Associated with the Control of Mycobacterium tuberculosis Infection in Humans[J]. J Immunol, 2019, 202(2): 421-427.
26 Zhang L, Ren Y, Liu Y. Comparison of the Effects of Lobectomy on Immunologic Function Between Video-Assisted Thoracoscopic Surgery and Traditional Open Surgery for Non-Small-Cell Lung Cancer[J]. Am J Ther, 2016, 23(6): e1406-e1413.
27 Huang S, Cao X, Li J, et al. Analgesic effect of flurbiprofen axetil in treatment of single hole thoracoscopic surgery for pneumothorax[J]. Pak J Pharm Sci, 2017, 30(5Special): 1875-1882.
28 Davenport L, Letson HL, Dobson GP. Immune-inflammatory activation after a single laparotomy in a rat model: effect of adenosine, lidocaine and Mg²⁺ infusion to dampen the stress response[J]. Innate Immun, 2017, 23(5): 482-494.
29 Beaussier M, Parc Y, Guechot J, et al. Ropivacaine preperitoneal wound infusion for pain relief and prevention of incisional hyperalgesia after laparoscopic colorectal surgery: a randomized, triple-arm, double-blind controlled evaluation vs intravenous lidocaine infusion, the CATCH study[J]. Colorectal Dis, 2018, 20(6): 509-519.
30 Klinger RY, Cooter M, Berger M, et al. Effect of intravenous lidocaine on the transcerebral inflammatory response during cardiac surgery: a randomized-controlled trial[J]. Can J Anaesth, 2016, 63(11): 1223-1232.

备注/Memo

备注/Memo:

基金项目: 江苏省徐州市重点研发计划(KC18173)
通信作者: 王晓宇, Email: 2958570090@qq.com

常用功能

更新日期/Last Update: 2020-08-20