天津医药

天津医药 ›› 2022, Vol. 50 ›› Issue (2): 181-185.doi: 10.11958/20211610

• 临床研究 • 上一篇    下一篇

氯胺酮和利多卡因对膝关节置换术患者止血带所致缺血再灌注损伤后自由基生成的影响

樊飞，雷碧波
  

  1. 成都中医药大学附属医院麻醉科（邮编610072）
  • 收稿日期:2021-07-13 修回日期:2021-09-16 出版日期:2022-02-15 发布日期:2022-02-15
  • 通讯作者: 雷碧波 E-mail:lihf88hs@163.com
  • 基金资助:
    成都中医药大学附属医院麻醉科（邮编610072）

Effects of ketamine and lidocaine on free radical production after tournique-induced ischemiareperfusion injury in patients undergoing knee arthroplasty #br#

FAN Fei, LEI Bibo #br#   

  1. Department of Anesthesiology, the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, China

  • Received:2021-07-13 Revised:2021-09-16 Published:2022-02-15 Online:2022-02-15

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摘要： 目的 评估静脉注射利多卡因与氯胺酮对膝关节置换术患者止血带所致缺血再灌注损伤后自由基生成 的影响。方法 纳入行膝关节置换术的患者120例，依据随机数字表法分为利多卡因组、氯胺酮组和生理盐水组，每 组40例。利多卡因组患者于麻醉诱导前10 min缓慢静脉注射利多卡因1 mg/kg；氯胺酮组患者于麻醉诱导前10 min 缓慢静脉注射氯胺酮0.5 mg/kg；生理盐水组患者静脉注射0.9%氯化钠注射液10 mL。记录3组患者麻醉前（T0）、输注干预药物后5 min（T1）、上止血带后30 min（T2）、撤止血带后15 min（T3）的心率（HR）、收缩压（SBP）、舒张压（DBP）。 于T0、T2、T3时点抽取外周静脉血检测全血乳酸水平和缺血修饰白蛋白（IMA）水平。记录患者拔管时间，术中低血 压和高血压发生率，术后恶心呕吐、苏醒期躁动、苏醒延迟等不良反应发生率。结果 最终共纳入113例患者，利多 卡因组、氯胺酮组和生理盐水组分别纳入38例、38例、37例患者。T1时点，氯胺酮组患者SBP、DBP、HR均高于利多 卡因组和生理盐水组（P＜0.05），利多卡因组和生理盐水组患者SBP、DBP、HR的比较差异无统计学意义（P＞0.05）。 T 2时点，氯胺酮组SBP、DBP较利多卡因组和生理盐水组明显升高（P＜0.05），HR比较差异无统计学意义（P＞0.05）。 T 3时点，3组患者SBP、DBP、HR比较差异无统计学意义。T2、T3时点，利多卡因组患者血乳酸和IMA水平明显低于氯 胺酮组和生理盐水组，而氯胺酮组低于生理盐水组，差异有统计学意义（P＜0.05）。3组患者拔管时间，术中高血压 和低血压发生率，术后恶心呕吐、苏醒期躁动、苏醒延迟发生率比较差异亦无统计学意义（P＞0.05）。结论 利多卡 因和氯胺酮均能对抗膝关节置换术患者止血带所致缺血再灌注损伤，但利多卡因效果更明显。

关键词: 利多卡因, 氯胺酮, 再灌注损伤, 乳酸, 关节成形术, 置换, 膝, 缺血修饰白蛋白

Abstract: ObjectiveTo evaluate the effects of different doses of ketamine and lidocaine on free radical production
after tournique-induced ischemia-reperfusion injury in patients undergoing knee arthroplasty. Methods A total of 120
patients who planned to undergo knee arthroplasty were included in this study. Patients were randomly divided into the
lidocaine group, the ketamine group and the saline group, with 40 patients in each group. The lidocaine group was given
lidocaine intravenously with 1 mg/kg 10 min before anesthesia induction. In the ketamine group, 0.5 mg/kg ketamine was
slowly injected intravenously 10 min before anesthesia induction. The saline group was intravenously injected with 0.9%
sodium chloride 10 mL. Data of systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) of three
groups were recorded before anesthesia (T0), 5 min after infusion of intervention drugs (T1), 30 min after applying tourniquet
(T2), and 15 min after removing tourniquet (T3). Peripheral venous blood samples were collected at T0, T2 and T3 to detect
lactic acid level and ischemia modifier albumin (IMA) level in the three groups. The time of extubation, incidence of
intraoperative hypotension, intraoperative hypertension, postoperative nausea and vomiting, agitation during recovery,
delayed awakening and other adverse reactions were recorded. ResultsA total of 113 patients were enrolled, including 38
in the lidocaine group, 38 in the ketamine group, and 37 in the saline group, respectively. At T1, SBP, DBP and HR were
higher in the ketamine group than those in the lidocaine group and saline group (P＜0.05). There were no significant
differences in SBP, DBP and HR between the lidocaine group and the saline group (P＞0.05). At T2, SBP and DBP were
significantly higher in the ketamine group than those in the lidocaine group and the saline group (P＜0.05), but there was no
significant difference in HR between the two groups (P＞0.05). At T3, there were no significant differences in SBP, DBP and
HR between the 3 groups. At T2 and T3, the serum levels of lactic acid and IMA were significantly lower in the lidocaine
group than those of the ketamine group and the saline group, while the level was significantly lower in the ketamine group
than that of the saline group (P＜0.05). There were no significant differences in the time of extubation, intraoperative
hypertension, incidence of intraoperative hypotension, postoperative nausea and vomiting, agitation in recovery period and
delay in recovery between the three groups (P＞0.05). Conclusion Both lidocaine and ketamine can protect against
tourniquet-induced ischemia-reperfusion injury in patients undergoing knee arthroplasty, but lidocaine is more effective.

Key words: lidocaine, ketamine, reperfusion injury, lactic acid, arthroplasty, replacement, knee, ischemia modifier albumin