利多卡因对颈淋巴结结核切除术患者围术期应激反应和免疫功能的影响

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摘要目的观察利多卡因对颈淋巴结结核切除术患者围术期应激反应及免疫功能的影响。方法选取2016年8月～2017年6月在我院择期行颈淋巴结结核切除术患者60例，采用随机数字表法将患者分为利多卡因组（L组）和对照组（C组）。L组气管插管前10 min给予负荷剂量利多卡因1.5 mg/kg，随后以1.5 mg/（kg·h）的速度泵注至术毕；C组持续泵入等容量的生理盐水。记录麻醉诱导前30 min（T0）、手术开始后1 h（T1）、术毕即刻（T2）及术后6 h（T3）的 MAP、HR；采用酶联免疫吸附法测定 T0～T3时血清去甲肾上腺素（NE）、肾上腺素（E）及皮质醇（Cor）浓度；采用流式细胞仪检测 T0～T3时 T淋巴细胞亚群（CD3+、CD4+、CD8+、CD4+/CD8+比值）及 NK 细胞的百分比。结果T1～T3时两组 MAP、HR 水平及血清 NE、E、Cor浓度明显高于 T0时，且 C 组明显高于 L 组（P＜0.05）。 T1～T3时，两组的CD3+、CD4+、CD8+和 CD4+/CD8+明显低于 T0时，且 C 组明显低于 L 组（P＜0.05），T1～T3时，两组的 NK 细胞水平明显高于T0时，且L组明显高于C组（P＜0.05）。结论静脉泵注利多卡因可有效抑制颈淋巴结结核切除术患者围术期应激反应，减少对细胞免疫功能的影响。

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	周田田
	陈自洋
	于淑侠
	张绍刚

关键词 ：利多卡因, 颈淋巴结结核, 应激反应, 免疫功能

Abstract：ObjectiveTo observe the influence of Lidocaine on the perioperative stress response and immunologic function in patients undergoing cervical lymph node tuberculosis resection.MethodsSixty patients scheduled for cervical lymph node tuberculosis resection from August 2016 to June 2017 in our hospital were selected.The patients were divided into Lidocaine group(group L)and control group(group C)according to the random number table method,and there were 30 patients in each group.Group L was administered 1.5 mg/kg bolus dose of Lidocaine before 10 min tracheal intubation,followed by 1.5 mg/（kg·h） infusion until the end of operation while group C was continuously pumped the equal capacity of normal saline.MAP,HR were recorded before 30 min anesthesia induction(T0),after 1 h operation initiation(T1),immediately after operation(T2),after 6 h operation(T3).Enzyme-linked immunosorbent assay was used to detect norepinephrine (NE),epinephrine (E),cortisol(Cor)at T0-T3.Flow cytometry was used to detect T lymphocytes(CD3+,CD4+,CD8+,CD4+/CD8+)and NK cells at T0-T3.ResultsCompared to those at T0,MAP,HR and stress hormones(NE,E,Cor)in both groups were significantly increased at T1-T3(P＜0.05),which was more significant in group C than that of group L(P＜0.05).The level of CD3+,CD4+,CD8+,CD4+/CD8+at T1-T3were significantly lower in both groups,and the levels in group C were obviously lower than those in group L(P＜0.05).The level of NK cells was higher at T1-T3in both groups,the level in group L was obviously higher than those in group C(P＜0.05).ConclusionIntravenous infusion of Lidocaine can suppress perioperative stress reaction effectively and reduce the influence on immunologic function of cell.

Key words： Lidocaine Cervical lymph node tuberculosis Stress reaction Immunologic function

引用本文:

周田田;陈自洋;于淑侠;张绍刚. 利多卡因对颈淋巴结结核切除术患者围术期应激反应和免疫功能的影响[J]. 中国当代医药, 2018, 25(3): 60-62转66.
ZHOU Tian-tian;CHEN Zi-yang;YU Shu-xia;ZHANG Shao-gang. The influence of Lidocaine on the perioperative stress reaction and immunologic function in patients undergoing cervical lymph node tuberculosis resection. 中国当代医药, 2018, 25(3): 60-62转66.

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