[1]王 旭,豆立冬,耿红芳.利多卡因联合七氟醚吸入在非体外循环冠状动脉旁路移植术中的心肌保护作用及其机制[J].新乡医学院学报,2017,34(7):579-582.[doi:10.7683/xxyxyxb.2017.07.006]
 WANG Xu,DOU Li-dong,GENG Hong-fang.Myocardial protective effect of lidocaine combined with sevoflurane inhalation in off-pump coronary artery bypass grafting and its mechanism[J].Journal of Xinxiang Medical University,2017,34(7):579-582.[doi:10.7683/xxyxyxb.2017.07.006]
点击复制

利多卡因联合七氟醚吸入在非体外循环冠状动脉旁路移植术中的心肌保护作用及其机制
分享到:

《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
34
期数:
2017年7
页码:
579-582
栏目:
临床研究
出版日期:
2017-07-05

文章信息/Info

Title:
Myocardial protective effect of lidocaine combined with sevoflurane inhalation in off-pump coronary artery bypass grafting and its mechanism
作者:
王 旭豆立冬耿红芳
(河南省人民医院麻醉科,河南 郑州 450003)
Author(s):
WANG XuDOU Li-dongGENG Hong-fang
(Department of Anesthesiology,Henan Provincial People′s Hospital,Zhengzhou 450003,Henan Province,China)
关键词:
利多卡因静脉输注七氟醚吸入冠状动脉粥样硬化性心脏病非体外循环冠状动脉旁路移植术心肌保护
Keywords:
lidocaine intravenoussevoflurane inhalationcoronary heart diseaseoff-pump coronary artery bypass surgerymyocardial protection
分类号:
R654
DOI:
10.7683/xxyxyxb.2017.07.006
文献标志码:
A
摘要:
目的 探讨利多卡因联合七氟醚吸入在非体外循环冠状动脉旁路移植术(OPCABG)中的心肌保护作用及其机制。方法 选择2014年1月至2015年12月在河南省人民医院接受OPCABG治疗的冠状动脉粥样硬化性心脏病患者98例作为研究对象,根据麻醉方法将患者分为观察组和对照组,每组49例。观察组患者采用利多卡因静脉输注联合七氟醚吸入进行麻醉,对照组患者采用利多卡因静脉输注进行麻醉,观察2种麻醉方法对患者的心肌保护效果、2组患者临床恢复情况及炎症因子表达水平等情况。结果 2组患者术前血浆中肌红蛋白(MYO)、肌酸激酶同工酶(CKMB)及心肌肌钙蛋白I(cTnI)水平比较差异均无统计学意义(P>0.05)。2组患者术后6 h MYO、CKMB及cTnI水平均高于术前 (P<0.05)。术后6 h,观察组患者血浆中MYO、CKMB及cTnI水平均明显低于对照组 (P<0.05)。观察组患者机械通气时间短于对照组,心律失常、心肌梗死及心绞痛的发生率明显低于对照组 (P<0.05)。2组患者术前血清中血管紧张素Ⅱ(Ang Ⅱ)、白细胞介素-6(IL-6)、IL-8及肿瘤坏死因子-α(TNF-α)水平比较差异均无统计学意义(P>0.05)。2组患者术后24 h Ang Ⅱ、IL-6、IL-8及TNF-α水平均高于术前 (P<0.05);术后24 h,观察组患者血清中Ang Ⅱ、IL-6、IL-8及TNF-α水平均显著低于对照组 (P<0.05)。结论 利多卡因静脉输注联合七氟醚吸入对行OPCABG患者具有较好的心肌保护作用,且能降低术后并发症的发生率。
Abstract:
Objective To explore the myocardial protective effect of lidocaine combined with sevoflurane inhalation in off-pump coronary artery bypass grafting(OPCABG) and its mechanism.Methods A total of 98 coronary heart disease patients who underwent OPCABG were selected in the Henan Provincial People′s Hospital from January 2014 to December 2015.The patients were divided into observation group(n=49) and control group(n=49) according to the anesthesia method.The patients in the observation group were given lidocaine intravenous infusion and sevoflurane inhalation;the patients in the control group were given lidocaine intravenous infusion.The myocardial protection effect,clinical recovery and inflammatory factor levels were observed in the two groups.Results There was no statistic difference in the plasma levels of myoglobin(MYO),creatine kinase isoenzyme(CKMB) and myocardial troponin(cTnI) between the two groups before operation (P>0.05).The levels of MYO,CKMB and cTnI in the two groups at 6 hours after operation were significantly higher than those before operation (P<0.05).The plasma levels of MYO,CKMB and cTnI in the observation group were significantly lower than those in the control group at 6 hours after operation(P<0.05).The mechanical ventilation time of patients in the observation group was significantly shorter than that in the control group (P<0.05);the incidence of arrhythmia,myocardial infarction and angina pectoris of patients in the observation group were significantly lower than those in the control group (P<0.05).There was no statistic difference in the serum levels of angiotensinⅡ(Ang Ⅱ),interleukin-6(IL-6),IL-8 and tumor necrosis factor-α(TNF-α)between the two groups before operation(P>0.05).The serum levels of Ang Ⅱ,IL-6,IL-8 and TNF-α of patients in the two groups at 24 hours after operation were significantly lower than those before operation (P<0.05).The serum levels of Ang Ⅱ,IL-6,IL-8 and TNF-α of patients in the observation group were significantly lower than those in the control group at 24 hours after operation(P<0.05).Conclusion Lidocaine intravenous infusion combined with sevoflurane inhalation has better myocardial protection effect on patients who undergo OPCABG,and it can reduce the incidence of postoperative complications.

参考文献/References:

[1] 柴晓芮,崔凯,叶中倪,等.高血压患者发生冠心病的相关危险因素分析[J].中华老年心脑血管病杂志,2016,18(6):590-592.
[2] CATENA C,COLUSSI G,NAIT F,et al.Elevated homocysteine levels are associated with the metabolic syndrome and cardiovas-cular events in hypertensive patients[J].Am J Hypertens,2015,28 (5):943-950.
[3] 郑智文,崔丹,李海燕,等.右美托咪定在老年患者非体外循环冠状动脉旁路移植术中的心肌保护作用[J].中国药房,2016,27(20):2836-2838.
[4] 吕绪磊,郝建华.气管插管后七氟醚预处理麻醉对肝门阻断术中患者的肠保护作用[J].新乡医学院学报,2016,33(4):305-307.
[5] 卢子会,黄长顺,黄自生,等.右美托咪啶对非体外循环冠状动脉旁路移植术的影响[J].中华全科医学,2014,12(4):525-527.
[6] 侯正友,赵聪.右美托咪定联合七氟醚及骶管阻滞麻醉在小儿下腹部手术中的应用[J].中华临床医师杂志,2015,9(22):4092-4095.
[7] 王玲,毕燕琳,马福国,等.七氟醚预吸入对行上腹部手术老年冠心病患者炎性因子的影响[J].中华实用诊断与治疗杂志,2013,27(2):169-171.
[8] 魏晓,田国刚.七氟醚预处理在脏器保护作用中的研究进展[J].中华临床医师杂志,2013,7(16):7535-7536.
[9] 程玉生,陆志伟.利多卡因对支气管镜检查的麻醉效果评价[J].中华肺部疾病杂志,2013,6(1):54-56.
[10] 何丹,张剑锋.成功救治利多卡因尿道表面麻醉致心脏骤停 1 例[J].中华灾害救援医学,2014,2(6):353-354.
[11] 芦相玉,周旋,胡春阳,等.复方利多卡因乳膏与利多卡因局部浸润麻醉用于老年患者清醒有创动脉穿刺镇痛效果及血流动力学变化的比较[J].中华临床医师杂志,2016,10(4):180.
[12] WHELTON S P,LEUKER T M,LUMENTHAL R S,et al.Improving cardiovascular disease risk prediction with albuminuria and glomerular filtration rate[J].Am J Kidney,2016,67 (1):179-181.
[13] PEIVANDI A A,DAHM M,HAKE U,et al.Patterns and diagnostic value of cardiac troponin I vs troponin T and CKMB after OPCAB surgery[J].Thorac Cardiovasc Surg,2001,49(3):137-143.
[14] TAKEDA S,NAKANISHI K,IKEZAKI H,et al.Cardiac marker responses to coronary artery bypass graft surgery with cardiopulmonary bypass and aortic cross-clamping[J].J Cardiothorac Vasc Anesth,2002,16(4):421-425.
[15] 张颖,赵其宏,顾尔伟,等.右美托咪定对CPB下心脏瓣膜置换术患者肠粘膜损伤的影响[J].中华麻醉学杂志,2015,35(2):154-157.
[16] 刘扬,吴安石,吴迪,等.静脉输注利多卡因联合七氟醚对非体外循环冠状动脉旁路移植术患者的心肌保护作用[J].中华麻醉学杂志,2015,35(2):149-153.
[17] 李晓晴,乔秋博,毕齐,等.老年非体外循环下冠状动脉旁路移植术后认知功能障碍的临床研究[J].中华老年心脑血管病杂志,2015,17(3):239-241.
[18] 赵广翊,赵柏松,曹岩岩,等.鞘内注射神经生长因子对利多卡因致大鼠脊髓神经毒性的影响[J].中华麻醉学杂志,2014,34(6):687-690.

更新日期/Last Update: 2017-07-05