利多卡因对老年胸科手术患者术后早期认知功能障碍的影响

发布时间：2018-05-12 06:07

本文选题：利多卡因 + 术后认知功能障碍　；参考：《山东医药》2017年06期

【摘要】：目的观察静脉输注利多卡因对老年胸科手术患者术后认知功能障碍(POCD)的影响。方法选择拟行胸科手术的老年患者40例,采用随机数字表法将患者分为观察组和对照组各20例。观察组给予利多卡因1.0mg/kg,于麻醉诱导前10 min内注射完毕,1.5 mg/(kg·h)静脉输注至缝皮结束。对照组以等体积生理盐水代替利多卡因。于术前1天(d_1)、术后第1天(d_2)和术后第3天(d_3)使用MMSE量表评估两组的认知功能状态,记录术后POCD的发生情况。于麻醉诱导前(T_1)、手术结束时(T_2)、术后第3天(T_3)抽取静脉血,检测血清IL-6、S-100β、神经元特异性烯醇化酶(NSE)水平。结果与d_1相比,两组d_2时的MMSE评分均降低,对照组d_3低于d_1(P均0.05);与对照组同时点比较,观察组d_2、d_3时的MMSE评分增高(P均0.05)。观察组d_2、d_3时的POCD发生率分别为10%、0,对照组分别为55%、25%,观察组POCD发生率较对照组低(P均0.05)。两组T_2、T_3时血清IL-6、S-100β、NSE水平均较T_1升高,但观察组低于对照组(P均0.05)。结论静脉输注利多卡因能够降低老年胸科手术患者POCD的发生率,其机制可能与减轻炎症反应、保护神经细胞有关。
[Abstract]:Objective to observe the effect of intravenous infusion of lidocaine on postoperative cognitive dysfunction (POCD) in elderly patients undergoing thoracic surgery. Methods A total of 40 elderly patients undergoing chest surgery were randomly divided into two groups: the observation group (n = 20) and the control group (n = 20). In the observation group, lidocaine 1.0 mg / kg was given intravenously to the end of suture skin 10 min before anesthesia induction. In the control group, lidocaine was replaced by the same volume of normal saline. MMSE scale was used to evaluate the cognitive function of the two groups and to record the occurrence of POCD after operation. Venous blood samples were collected before anesthesia induction and at the end of operation, respectively. The serum levels of IL-6 S-100 尾 and neuron-specific enolase (NSEs) were measured. Results compared with d 1, the MMSE scores in the two groups were lower than those in the control group, and the MMSE scores in the observation group were 0.05% higher than those in the control group at the same time. The incidence of POCD in the observation group was 10 0 and that in the control group was 55 and 25 respectively. The incidence of POCD in the observation group was lower than that in the control group (P < 0.05). The level of serum IL-6 S-100 尾 -NSE in both groups was higher than that in Tap1 group, but it was lower in the observation group than that in the control group (P < 0.05). Conclusion intravenous infusion of lidocaine can reduce the incidence of POCD in elderly patients undergoing thoracic surgery, and its mechanism may be related to the reduction of inflammation and the protection of nerve cells.
【作者单位】：淮安市第二人民医院;南京中大医院;
【基金】：江苏省“333工程”培养资金资助项目(BRA2014131)
【分类号】：R614

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