Wang Dongxin, Wu Xinmin, Li Jun, Xiao Feng, Liu Xiaoying, Meng Meijin
Department of Anesthesiology, First Hospital, Peking University, No. 8 Xishiku Street, Beijing 100034, China.
Anesth Analg. 2002 Nov;95(5):1134-41, table of contents. doi: 10.1097/00000539-200211000-00002.
We investigated the effect of lidocaine on the incidence of cognitive dysfunction in the early postoperative period after cardiac surgery. One-hundred-eighteen patients undergoing elective coronary artery bypass surgery with cardiopulmonary bypass (CPB) were randomized to receive either lidocaine (1.5 mg/kg bolus followed by a 4 mg/min infusion during operation and 4 mg/kg in the priming solution of CPB) or placebo. A battery of nine neuropsychological tests was administered before and 9 days after surgery. A postoperative deficit in any test was defined as a decline by more than or equal to the preoperative SD of that test in all patients. Any patient showing a deficit in two or more tests was defined as having postoperative cognitive dysfunction. Eighty-eight patients completed pre- and postoperative neuropsychological tests. Plasma lidocaine concentrations (microg/mL) were 4.78 +/- 0.52 (mean +/- SD), 5.38 +/- 0.95, 4.52 +/- 0.39, 5.82 +/- 0.76, and 7.10 +/- 1.09 at 10 min before CPB; 10, 30, and 60 min of CPB; and at the end of operation, respectively. The proportion of patients showing postoperative cognitive dysfunction was significantly reduced in the lidocaine group compared with that in the placebo group (18.6% versus 40.0%; P = 0.028). We conclude that intraoperative administration of lidocaine decreased the occurrence of cognitive dysfunction in the early postoperative period.
Postoperative cognitive dysfunction is a commonly recognized complication after cardiac surgery. Intraoperative cerebral microembolism and hypoperfusion have been proposed to be the major mechanisms. The results of this study show that intraoperative administration of lidocaine decreased the occurrence of early postoperative cognitive dysfunction, perhaps because of its neuroprotective effects.
我们研究了利多卡因对心脏手术后早期认知功能障碍发生率的影响。118例接受体外循环（CPB）下择期冠状动脉搭桥手术的患者被随机分为两组，分别接受利多卡因（术中静脉推注1.5mg/kg，随后以4mg/min持续输注，并在CPB预充液中加入4mg/kg）或安慰剂。在手术前及术后9天进行了一系列九项神经心理学测试。所有患者中，任何一项测试术后出现缺陷定义为较术前该测试标准差下降大于或等于该标准差。任何在两项或更多测试中出现缺陷的患者被定义为患有术后认知功能障碍。88例患者完成了术前和术后神经心理学测试。CPB前10分钟、CPB开始后10、30和60分钟以及手术结束时的血浆利多卡因浓度（μg/mL）分别为4.78±0.52（均值±标准差）、5.38±0.95、4.52±0.39、5.82±0.76和7.10±1.09。与安慰剂组相比，利多卡因组术后出现认知功能障碍的患者比例显著降低（18.6%对40.0%；P = 0.028）。我们得出结论，术中给予利多卡因可降低术后早期认知功能障碍的发生率。
术后认知功能障碍是心脏手术后常见的并发症。术中脑微栓塞和低灌注被认为是主要机制。本研究结果表明，术中给予利多卡因可降低术后早期认知功能障碍的发生率，可能是由于其神经保护作用。
