右美托咪定联合利多卡因预处理对胸腔镜肺癌根治术患者围术期心脏不良事件的影响

Effect of dexmedetomidine combined with lidocaine pretreatment on perioperative cardiac events in patients undergoing thoracoscopic lung cancer surgery

摘要:

目的：观察右美托咪定联合利多卡因预处理对胸腔镜肺癌根治术患者围术期心脏不良事件的影响。方法：择期行胸腔镜肺癌根治术的患者80例，采用随机数字表法将其分为右美托咪定联合利多卡因预处理组（DL组）与对照组（C组），每组40例，分别在麻醉诱导时静脉泵入右美托咪定1 μg/（kg·h）及利多卡因2 mg/（kg·h）或生理盐水，持续泵注30 min。于术前，术后24、48、72 h采集静脉血标本，测定血清超敏肌钙蛋白T（hypersensitivity troponin T，hs-cTnT）和N-末端脑利钠肽原（N-terminal pro-brain natriuretic peptide，NT-proBNP）水平。记录术中、术后30 d心脏不良事件的发生情况。结果：2组患者术前血清hs-cTnT和NT-proBNP水平差异无统计学意义（P>0.05），术后48、72 h时血清hs-cTnT水平和术后24、48、72 h时NT-proBNP水平较术前明显升高（P<0.05）；DL组在术后48 h时血清hs-cTnT水平和术后24、48、72 h时NT-proBNP水平明显低于C组（P<0.05）。2组患者术中术后均未发生心肌梗死和心脏骤停。DL组术中房性早搏的发生率及术后30 d无症状性心肌缺血和心律失常发生率明显低于C组（P<0.05）。结论：右美托咪定联合利多卡因预处理可降低胸腔镜肺癌根治术患者围术期心肌损伤标志物水平及心脏不良事件的发生率。

Abstract:

Objective：To observe the effect of dexmedetomidine combined with lidocaine pretreatment on perioperative cardiac events in patients undergoing thoracoscopic lung cancer surgery. Methods：Eighty patients undergoing thoracoscopic lung cancer surgery were randomly divided into two groups：the dexmedetomidine combined with lidocaine pretreatment group（group DL，n=40） and the control group（group C，n=40）. 1 μg/（kg·h） dexmedetomidine and 2 mg/（kg·h） lidocaine in group DL，and saline in group C was administered during anesthesia induction and last for 30 minutes. The serum level of hs-cTnT and NT-proBNP was measured before operation，as well as 24 h，48 h and 72 h after operation，and the incidence of cardiac events during operation and within 30 days after operation was recorded. Results：There was no significant difference in levels of hs-cTnT and NT-proBNP between the two groups before operation（P>0.05），but the levels of hs-cTnT at 48 h and 72 h and the levels of NT-proBNP at 24 h，48 h and 72 h after operation were significantly higher than those before operation. The levels of hs-cTnT at 48 h and the levels of NT-proBNP at 24 h，48 h and 72 h after operation in group DL were significantly lower than those in group C（P<0.05）. There were no myocardial infarc－tion and cardiac arrest event after operation in both groups. The incidence of intraoperative atrial premature，asymptomatic myocardial ischemia and arrhythmia in group DL was significantly lower than those in group C（P<0.05）. Conclusion：Pretreatment of dexmedeto－midine combined with lidocaine can reduce the levels of my－ocardial injury markers and the incidence of cardiac events in patients undergoing thoracic lung cancer surgery.