摘要
目的评价术中应用利多卡因能否减少冠脉分流手术后病人早期认知功能障碍的发生率。方法118例择期体外循环下行冠状动脉分流术的病人随机分为两组。利多卡因组(n=57)在切开心包后静注利多卡因1.5 mg/kg,继以4 mg/min持续输注至术毕,体外循环预充液中另加4mg/kg;对照组(n=61)给予等量生理盐水。分别在术前1 d和术后第9天对病人进行神经精神功能9项测验。各测验项目术后值与术前值相比功能降低等于或超过全部病人该项目术前值的1个标准差判断该项测验出现术后功能恶化;一个病人有2个或2个以上的测验项目术后出现功能恶化判断该病人发生了术后认知功能障碍。结果 88例病人全部完成手术前后神经精神功能测验,其中对照组45例、利多卡因组43例。术后认知功能障碍发生率对照组为42.2％(19例)、利多卡因组为20.9％(9例),利多卡因组明显低于对照组(P<0.05)。结论术中给予利多卡因可明显降低体外循环下冠脉分流手术后病人早期认知功能障碍的发生率。
Objective To investigate if lidocaine can decrease the incidence of cognitive dysfunction in the early postoperative period after coronary artery bypass graft (CABG) surgery performed under cardiopulmonary bypass (CPB) .Methods One-hundred and eighteen patients (114 male, 4 female) aged 36-75 yr undergoing elective CABG with CPB were randomly divided into two groups : control group ( n - 61) and lidocaine group ( n = 57). The exclusion criteria included age > 75 yr, a history of neurologic or mental disease, preoperative left ventricular ejection fraction < 35% , serum creatinine in excess of 177 μmol · L-1 and active liver disease. In lidocaine group a bolus dose of lidocaine (1.5 mg·kg-1) was given i.v. while the pericardium was being opened, followed by continuous infusion of lidocaine at a rate of 4 mg · min-1 throughout the operation. Another bolus dose of lidocaine (4mg·kg-1 ) was added to the prime. In control group normal saline was given instead of lidocaine in the same volume and at the same speed. A battery of 9 neuropsychological tests was performed and scored preoperatively and 9 days after surgery. The mean score and standard deviation of each test were calculated. A postoperative deficit in any test was defined as the difference in score before and after surgery greater than the standard deviation. Any patient having deficit in 2 or more tests was deemed to have postoperative cognitive dysfunction. The patients were premeditated with oral midazolum 7.5 mg and intramuscular morphine 10 mg. Anesthesia was induced and maintained with fentanyl, midazolum and vecuronium, supplemented with isoflurane ( < 1%) before CPB and propofol infusion (2.5-4 mg·kg-1 ·h-1 ) during CPB. ECG, radial artery pressure, pulmonary artery pressure, SpO2 , PET CO, and urinary output were continuously monitored during operation. In lidocaine group blood samples were taken from radial artery 10 min before CPB (T1 ), 10, 30, 60 min after initiation of CPB (T2, 3, 4 ) and at the end of surgery (T5) for determination of plasma lidocaine concentration in 6 patients using gas chromatography (Shimadzu GC-7A, Japan) . Results Eighty-eight patients completed both pre-and postoperative neuropsychological tests. Forty-five of the 88 patients belonged to the control group and forty- three to the lidocaine group. The mean plasma lidocaine concentrations were 4.8 ±0.5 μg·ml-1 (T, ) , 5.4 ± 0.9 μg·ml-1(T2), 4.5±0.4μg·ml-1(T3) 5.8 ± 0.8 μg· ml-1 (T4 ) and 7.1 ± 1.1 μg·ml-1 (T5 ) respectively. Postoperative cognitive dysfunction occurred in 19 patients (42.2 % ) in the control group and in 9 patients (20.9% ) in the lidocaine group. The incidence of postoperative cognitive dysfunction was significantly reduced in the lidocaine group compared with the control group ( P < 0.05) .Conclusion Lidocaine administered during operation decreases the incidence of cognitive dysfunction in the early postoperative period after CABG with CPB.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2004年第2期85-89,共5页
Chinese Journal of Anesthesiology
基金
卫生部基金资助项目(96-1-264)
关键词
利多卡因
心脏手术
认知功能障碍
体外循环
术后
Lidocaine
Brain
Cognition disorders
Cardiopulmonary bypass
Coronary artery bypass
Postoperatvis period
