目的 研究静脉使用利多卡因对术后肺部并发症中高风险患者肺损伤血清生物标志物和炎性因子以及肺部氧合情况和术后肺部并发症的影响，探讨利多卡因对术后肺部并发症中高风险患者的肺保护作用。 方法 选择124名行全麻气管插管，年龄≥18岁，ASA分级II-III级，根据手术病人呼吸系统并发症风险评估量表（‘Assess Respiratory Risk in Surgical Patients in Catalonia’ risk score ,ARISCAT评分量表）有肺部并发症中高风险（≥26分）患者，用随机数字表将患者分到B组（利多卡因组）和C组（生理盐水组），每组62例。B组在麻醉诱导后即刻静脉给予利多卡因1.5mg/kg,术中以1mg·kg-1·h-1速度持续泵注利多卡因；C组给与等量生理盐水。所有患者分别于麻醉诱导前（T0）,机械通气1h（T1）,机械通气2h（T2）,术毕（T3）,术后24h（T4）检测静脉血中肺损伤血清生物标志物克拉拉细胞分泌蛋白（clara cell secretory proteins,CC16)和炎性因子IL-6,IL-10的水平，并于T0,T1,T2,T3行动脉血气分析，计算氧合指数(oxygen index, OI), 肺泡动脉氧分压差(alveolar-arterial oxygen difference,A-aDO2),呼吸指数(respiratory index,RI)。并记录术中机械通气时间、术中液体输注情况、患者住院时长、入ICU率以及术后30天内肺部并发症发生情况。 结果 两组患者血清中CC16蛋白浓度在T2、T3时刻，利多卡因组的CC16蛋白浓度水平低于对照组（P0.05）。与对照组比较，利多卡因组IL-6水平在T3、T4明显降低（P0.05），IL-10水平差异无统计学意义（P0.05）。在T2、T3时刻，利多卡因组的OI明显高于对照组，A-aDO2低于对照组（P0.05）,RI值在各时间点两组之间差异无统计学意义(P0.05)。利多卡因组术后肺部并发症发生率低于对照组（P0.05）。 结论 静脉使用利多卡因可能通过抑制炎症反应减轻肺部并发症中高风险患者行腹部大手术后的肺损伤，改善肺部氧合，降低围术期肺部并发症发生率从而改善患者预后。
Objective To study the lung protective effects of intravenous lidocaine on patients at intermediate to high risk of postoperative pulmonary complications(PPCs),by observing changes of plasma markers of lung injury and inflammatory mediators, pulmonary oxygenation and PPCs Methods. 124 patients scheduled for endotracheal intubation under general anesthesia ,age ≥18 years old, ASA physical status II-III, with an intermediate-to-high risk for postoperative pulmonary complications( as defined by the ‘Assess Respiratory Risk in Surgical Patients in Catalonia’ risk score (ARISCAT score) were enrolled.They were divided into two groups (n=62),lidocaine group(group L)，（each group=62）:bolus injection of 1.5 mg/kg lidocaine at induction of anesthesia,then a continuous infusion of 1mg·kg-1·h-1 intraoperatively.control group (group C):equivalent normal saline in place of lidocaine was given to patients .venous blood for plasma markers of lung injury and inflammatory mediators were collectsd at the following time points: before induction of anesthesia(T0), 1 hour after mechanical ventilation (T1), 2 hours after mechanical ventilation (T2),the finish of surgery (T3), 24 h after surgery(T4),These mediators included clara cell secretory protein(CC16 protein),IL-6 and IL-10.arterial blood gas analysis were recorded at T0,T1,T2 and T3.calculated the oxygen index (OI), alveolar-arterial oxygen difference (A-aDO2), respiratory index (RI). intraoperative mechanical ventilation time, intraoperative fluid intake and outflow ,length of hospital stay, ICU admission rate, and pulmonary complications within 30 days after surgery were also recorded. Results It was demonstrated that the the plasma concentrations of CC16 protein in lidocaine group at T2-T3 were lower than that in the cantrol group (P＜0.05),and Compared with the control group , IL-6 level in the lidocaine group were decreased (P＜0.05) ,At T2 and T3, OI values of the lidocaine group was significantly higher than that of the control group, and A-aDO2 was lower than that of the control group (P 0.05). There was no significant difference in RI values between the two groups at each time point (P0.05).The incidence of postoperative pulmonary complications in the lidocaine group was lower than that in the control group (P0.05). Conclusion Intravenous use of lidocaine may attenuate lung injury on patientson patients at intermediate to high risk of PPCs by inhibiting inflammatory response and improve pulmonary oxygenation,reduce the incidence of perioperative pulmonary Complications and then improve the prognosis of the patients.
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