利多卡因辅助麻醉在老年创伤性颈胸段脊髓损伤减压手术的应用
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摘要
目的探讨利多卡因辅助麻醉在老年创伤性颈胸段脊髓损伤减压手术的应用方法与效果。方法回顾性分析2015年2月—2017年12月在湖北医药学院附属襄阳市第一人民医院进行诊治的创伤性颈胸段脊髓损伤老年患者78例的临床资料,其中男性42例,女性36例;平均年龄(68.24±3.22)岁;道路交通伤41例,高处坠落伤21例,重物砸伤9例,运动损伤7例。根据麻醉方法不同分为利多卡因组(利多卡因辅助麻醉)与右美托咪定组(右美托咪定辅助麻醉)各39例,两组均给予减压手术治疗。记录、观察两组围手术期并发症情况、术后脊髓神经功能、术后日本骨科协会颈椎评分系统(JOA)评分、术后血清肿瘤坏死因子-α(TNF-α)和白介素-6(IL-6)水平及患者麻醉满意度。结果患者均顺利完成手术与麻醉,围手术期无严重并发症发生,两组患者在麻醉前、术后1h的收缩压、舒张压、心率无显著波动(P>0.05)。术后3d利多卡因组中脊髓神经功能0级1例,Ⅰ级2例,Ⅱ级2例,Ⅲ级4例,Ⅳ级30例;右美托咪定组中分别为5、6、8、10与10例(P<0.05)。利多卡因组与右美托咪定组术后3个月的JOA评分均高于术后3d,利多卡因组高于右美托咪定组(P<0.05)。两组术后14d的血清TNF-α、IL-6值低于术后1d,利多卡因组低于右美托咪定组(P<0.05)。术后14d利多卡因组与右美托咪定组的麻醉满意度分别为100.0%和84.6%(P<0.05)。结论利多卡因辅助麻醉应用于老年创伤性颈胸段脊髓损伤减压手术具有很好的安全性,能促进保护脊髓神经功能与改善颈椎功能,抑制炎症因子的释放,具有很好的麻醉效果。
Objective To explore the application methods and effects of lidocaine in anesthesia in elderly patients with traumatic cervical thoracic spinal cord injury. Methods From Feb. 2015 to Dec.2017,78 elderly patients with traumatic cervical thoracic spinal cord injury were treated in our hospital. There were 42 males and 36 females,with an average age of(68.24±3.22) years. There were 41 traffic accidents injuries,21 high-altitude fall injuries,9 heavy-weight injuries,and 7 sports injuries. All the patients were divided into the observation group and the control group according to the different anesthesia methods,with 39 cases in each group. The two groups were both treated with decompression,the observation group were given the lidocaine for anesthesia,while the control group were given dexmedetomidine for anesthesia,and the complication,spinal cord function,JOA,TNF-α,IL-6 and prognosis of the two groups were recorded and observed. Results All patients were completed the operation and anesthesia successfully and there was no serious complication in the perioperative period. There was no significant fluctuation in the systolic pressure,diastolic pressure and heart rate of the two groups before and after the induction of anesthesia(P>0.05). In the observation group,the spinal nerve function showed grade 0 in 1 case,grade I in 2 cases,grade Ⅱ in 2 cases,grade Ⅲ in 4 cases,and grade IV in 30 cases; in the control group,the spinal nerve function showed grade 0 in 5 cases,grade I in 6 cases,grade Ⅱ in 8 cases,grade Ⅲ in 10 cases,and grade IV in 10 cases(P<0.05). The JOA scores of the observation group and the control group at postoperative 3 months were higher than those at postoperative days 3,which were higher in the observation group than those of the control group(P<0.05). The serum levels of TNF-α and IL-6 at 14 days after operation in the two groups were lower than those at 1 day after operation,which were lower in the observation group than those of the control group(P<0.05). The anesthesia satisfaction of the observation group and the control group at 14 days after surgery was 100.0% and 84.6%,respectively(P<0.05).Conclusion The application of lidocaine for anesthesia in elderly patients with traumatic cervical thoracic spinal cord injury has good safety,which can promote the protection of spinal nerve function,improve the function of cervical vertebra,and inhibit the release of inflammatory factors. Hence,it has good anesthetic effects.
Objective To explore the application methods and effects of lidocaine in anesthesia in elderly patients with traumatic cervical thoracic spinal cord injury. Methods From Feb. 2015 to Dec.2017,78 elderly patients with traumatic cervical thoracic spinal cord injury were treated in our hospital. There were 42 males and 36 females,with an average age of(68.24±3.22) years. There were 41 traffic accidents injuries,21 high-altitude fall injuries,9 heavy-weight injuries,and 7 sports injuries. All the patients were divided into the observation group and the control group according to the different anesthesia methods,with 39 cases in each group. The two groups were both treated with decompression,the observation group were given the lidocaine for anesthesia,while the control group were given dexmedetomidine for anesthesia,and the complication,spinal cord function,JOA,TNF-α,IL-6 and prognosis of the two groups were recorded and observed. Results All patients were completed the operation and anesthesia successfully and there was no serious complication in the perioperative period. There was no significant fluctuation in the systolic pressure,diastolic pressure and heart rate of the two groups before and after the induction of anesthesia(P>0.05). In the observation group,the spinal nerve function showed grade 0 in 1 case,grade I in 2 cases,grade Ⅱ in 2 cases,grade Ⅲ in 4 cases,and grade IV in 30 cases; in the control group,the spinal nerve function showed grade 0 in 5 cases,grade I in 6 cases,grade Ⅱ in 8 cases,grade Ⅲ in 10 cases,and grade IV in 10 cases(P<0.05). The JOA scores of the observation group and the control group at postoperative 3 months were higher than those at postoperative days 3,which were higher in the observation group than those of the control group(P<0.05). The serum levels of TNF-α and IL-6 at 14 days after operation in the two groups were lower than those at 1 day after operation,which were lower in the observation group than those of the control group(P<0.05). The anesthesia satisfaction of the observation group and the control group at 14 days after surgery was 100.0% and 84.6%,respectively(P<0.05).Conclusion The application of lidocaine for anesthesia in elderly patients with traumatic cervical thoracic spinal cord injury has good safety,which can promote the protection of spinal nerve function,improve the function of cervical vertebra,and inhibit the release of inflammatory factors. Hence,it has good anesthetic effects.
引文
[1] Freo U,Ambrosio F,Furnari M,et al.Lidocaine 5% medicated plaster for spinal neuropathic pain[J].J Pain Palliat Care Pharmacother,2016,30(2):111-113.
[2] 吴春娴.鞘内注射右美托咪定对利多卡因致大鼠脊髓神经毒性的影响[J].浙江临床医学,2016,18(3):458-459,465.
[3] Le?o P,Figueiredo P.Autonomic hyperreflexia after spinal cord injury managed successfully with intravenous lidocaine: a case report[J].Patient Saf Surg,2016,15(10):99-103.
[4] 赵广翊,丁旭东,周静.利多卡因复合布比卡因或罗哌卡因鞘内注射对大鼠脊髓神经毒性的影响[J].临床麻醉学杂志,2016,32(9):905-909.
[5] Panicker JN,Seth JH,Khan S,et al.Open-label study evaluating outpatient urethral sphincter injections of onabotulinumtoxinA to treat women with urinary retention due to a primary disorder of sphincter relaxation(Fowler’s syndrome)[J].BJU Int,2016,117(5):809-813.
[6] Kalliom?ki J,Jonzon B,Huizar K,et al.Evaluation of a novel chemokine receptor 2 (CCR2)-antagonist in painful diabetic polyneuropathy[J].Scand J Pain,2017,4(2):77-83.
[7] Chen W,Taché Y,Marvizón JC.Corticotropin-releasing factor in the brain and blocking spinal descending signals induce hyperalgesia in the latent sensitization model of chronic pain[J].Neuroscience,2018,15(381):149-158.
[8] 金允淑,马虹.盐酸利多卡因与甲磺酸罗哌卡因分别及联合应用于臂丛神经阻滞的临床观察[J].中国医药指南,2016,12(5):63-63.
[9] Shields LBE,Iyer VG,Zhang YP,et al.Acute cauda equina syndrome following orthopedic procedures as a result of epidural anesthesia[J].Surg Neurol Int,2018,10(9):81.
[10] Contreras-Hernández E,Chávez D,Hernández E,et al.Supraspinal modulation of neuronal synchronization by nociceptive stimulation induces an enduring reorganization of dorsal horn neuronal connectivity[J].J Physiol,2018,596(9):1747-1776.
[11] 覃思平,周增华,蒋宗滨,等.NF-κB在右美托咪定抑制利多卡因神经毒性中的作用[J].中国现代医学杂志,2017,27(23):1-6.
[12] Kan H,Wang Y,Wang D,et al.Cordycepin rescues lidocaine-induced neurotoxicity in dorsal root ganglion by interacting with inflammatory signaling pathway MMP3[J].Eur J Pharmacol,2018,827:88-93.
[13] Chtompel Y,Eghtesadi M,Vargas-Schaffer G.A case report of refractory notalgia paresthetica treated with lidocaine infusions[J].Am J Case Rep,2017,18:1225-1228.
[14] Vaidyanathan S,Soni BM,Mansour P,et al.Fatal collapse due to autonomic dysreflexia during manual self-evacuation of bowel in a tetraplegic patient living alone: lessons to learn[J].Int Med Case Rep J,2017,10:361-365.
[15] 姜景卫,鲁华荣,毛桂琴,等.右美托咪定鞘内注射对老年患者硬膜外麻醉效果及术后认知功能的影响[J].中国老年学杂志,2016,36(22):5661-5664.
[16] Zhang Y,Tao GJ,Hu L,et al.Lidocaine alleviates morphine tolerance via AMPK-SOCS3-dependent neuroinflammation suppression in the spinal cord[J].J Neuroinflamm,2017,14(1):211.
[17] Végh D,Somogyi A,Bányai D,et al.Effects of articaine on [(3)H] noradrenaline release from cortical and spinal cord slices prepared from normal and streptozotocin-induced diabetic rats and compared to lidocaine[J].Brain Res Bull,2017,135:157-162.
[18] Yousefshahi F,Predescu O,Francisco Asenjo J.The efficacy of systemic lidocaine in the management of chronic pain: a literature review[J].Anesth Pain Med,2017,7(3):e44732.
[19] 陈戟,谭秀华,庞韬,等.右美托咪定对利多卡因致大鼠脊髓神经损伤的影响[J].中国医药导报,2017,14(9):22-25.
[20] Zhao G,Li D,Ding X,et al.Nerve growth factor pretreatment inhibits lidocaine-induced myelin damage via increasing BDNF expression and inhibiting p38 mitogen activation in the rat spinal cord[J].Mol Med Rep,2017,16(4):4678-4684.
[21] Esposito G,Capoccia E,Gigli S,et al.HIV-1 Tat-induced diarrhea evokes an enteric glia-dependent neuroinflammatory response in the central nervous system[J].Sci Rep,2017,7(1):7735.
[22] 游仁芳,许福生,王少平.利多卡因对老年肺癌根治术患者围术期脑氧代谢及术后早期认知功能影响[J].临床军医杂志,2016,21(1):64-67.
[23] Zheng X,Chen L,Du X,et al.Effects of hyperbaric factors on lidocaine-induced apoptosis in spinal neurons and the role of p38 mitogen-activated protein kinase in rats with diabetic neuropathic pain[J].Exp Ther Med,2017,13(6):2855-2861.
[24] Otis C,Guillot M,Moreau M,et al.Spinal neuropeptide modulation,functional assessment and cartilage lesions in a monosodium iodoacetate rat model of osteoarthritis[J].Neuropeptides,2017,10(65):56-62.
[25] 曲晓云,葛友娥.创伤性颈胸段脊髓损伤减压手术的麻醉处理研究[J].中国实用医药,2016,2(01):152-153.
[26] Dai Z,Huang C,Zhao Q,et al.Effects of extrinsic cardiac nerve stimulation on atrial fibrillation inducibility: the regulatory role of the spinal cord[J].J Cardiovasc Electrophysiol,2017,28(7):819-827.
[27] 党培业,杨智泉,王彦东,等.帕瑞昔布钠联合利多卡因在腰椎开放性手术围手术期镇痛中的疗效观察[J].中华全科医学,2017,15(3):371-374.
[28] Cheng KI,Wang HC,Wu YC,et al.Sciatic nerve intra-fascicular lidocaine injection-induced peripheral neuropathic pain: alleviation by systemic minocycline administration[J].Clin J Pain,2015,8(3):114-116.
[29] Hagen EM,Rekand T.Management of neuropathic pain associated with spinal cord injury[J].Pain Ther,2015,4(1):51-55.
[30] 徐海平,赵柏松,佘应军,等.右美托咪定对利多卡因诱发大鼠脊髓神经毒性时BDNF表达的影响[J].中华麻醉学杂志,2016,36(10):1197-1201.
[31] Kumar R,Prasoon P,Gautam M,et al.Comparative antinociceptive effect of arachidonylcyclopropylamide,a cannabinoid 1 receptor agonist & lignocaine,a local anaesthetic agent,following direct intrawound administration in rats[J].Indian J Med Res,2016,144(5):730-740.
[32] 梁东科,张炳东,王丰.复方利多卡因乳膏和艾司洛尔对老年患者双腔支气管插管围插管期应激反应的影响[J].中国老年学杂志,2016,36(4):907-909.
[33] David-Pereira A,Sagalajev B,Wei H,et al.The medullary dorsal reticular nucleus as a relay for descending pronociception induced by the mGluR5 in the rat infralimbic cortex[J].Neuroscience,2017,349:341-354.
[2] 吴春娴.鞘内注射右美托咪定对利多卡因致大鼠脊髓神经毒性的影响[J].浙江临床医学,2016,18(3):458-459,465.
[3] Le?o P,Figueiredo P.Autonomic hyperreflexia after spinal cord injury managed successfully with intravenous lidocaine: a case report[J].Patient Saf Surg,2016,15(10):99-103.
[4] 赵广翊,丁旭东,周静.利多卡因复合布比卡因或罗哌卡因鞘内注射对大鼠脊髓神经毒性的影响[J].临床麻醉学杂志,2016,32(9):905-909.
[5] Panicker JN,Seth JH,Khan S,et al.Open-label study evaluating outpatient urethral sphincter injections of onabotulinumtoxinA to treat women with urinary retention due to a primary disorder of sphincter relaxation(Fowler’s syndrome)[J].BJU Int,2016,117(5):809-813.
[6] Kalliom?ki J,Jonzon B,Huizar K,et al.Evaluation of a novel chemokine receptor 2 (CCR2)-antagonist in painful diabetic polyneuropathy[J].Scand J Pain,2017,4(2):77-83.
[7] Chen W,Taché Y,Marvizón JC.Corticotropin-releasing factor in the brain and blocking spinal descending signals induce hyperalgesia in the latent sensitization model of chronic pain[J].Neuroscience,2018,15(381):149-158.
[8] 金允淑,马虹.盐酸利多卡因与甲磺酸罗哌卡因分别及联合应用于臂丛神经阻滞的临床观察[J].中国医药指南,2016,12(5):63-63.
[9] Shields LBE,Iyer VG,Zhang YP,et al.Acute cauda equina syndrome following orthopedic procedures as a result of epidural anesthesia[J].Surg Neurol Int,2018,10(9):81.
[10] Contreras-Hernández E,Chávez D,Hernández E,et al.Supraspinal modulation of neuronal synchronization by nociceptive stimulation induces an enduring reorganization of dorsal horn neuronal connectivity[J].J Physiol,2018,596(9):1747-1776.
[11] 覃思平,周增华,蒋宗滨,等.NF-κB在右美托咪定抑制利多卡因神经毒性中的作用[J].中国现代医学杂志,2017,27(23):1-6.
[12] Kan H,Wang Y,Wang D,et al.Cordycepin rescues lidocaine-induced neurotoxicity in dorsal root ganglion by interacting with inflammatory signaling pathway MMP3[J].Eur J Pharmacol,2018,827:88-93.
[13] Chtompel Y,Eghtesadi M,Vargas-Schaffer G.A case report of refractory notalgia paresthetica treated with lidocaine infusions[J].Am J Case Rep,2017,18:1225-1228.
[14] Vaidyanathan S,Soni BM,Mansour P,et al.Fatal collapse due to autonomic dysreflexia during manual self-evacuation of bowel in a tetraplegic patient living alone: lessons to learn[J].Int Med Case Rep J,2017,10:361-365.
[15] 姜景卫,鲁华荣,毛桂琴,等.右美托咪定鞘内注射对老年患者硬膜外麻醉效果及术后认知功能的影响[J].中国老年学杂志,2016,36(22):5661-5664.
[16] Zhang Y,Tao GJ,Hu L,et al.Lidocaine alleviates morphine tolerance via AMPK-SOCS3-dependent neuroinflammation suppression in the spinal cord[J].J Neuroinflamm,2017,14(1):211.
[17] Végh D,Somogyi A,Bányai D,et al.Effects of articaine on [(3)H] noradrenaline release from cortical and spinal cord slices prepared from normal and streptozotocin-induced diabetic rats and compared to lidocaine[J].Brain Res Bull,2017,135:157-162.
[18] Yousefshahi F,Predescu O,Francisco Asenjo J.The efficacy of systemic lidocaine in the management of chronic pain: a literature review[J].Anesth Pain Med,2017,7(3):e44732.
[19] 陈戟,谭秀华,庞韬,等.右美托咪定对利多卡因致大鼠脊髓神经损伤的影响[J].中国医药导报,2017,14(9):22-25.
[20] Zhao G,Li D,Ding X,et al.Nerve growth factor pretreatment inhibits lidocaine-induced myelin damage via increasing BDNF expression and inhibiting p38 mitogen activation in the rat spinal cord[J].Mol Med Rep,2017,16(4):4678-4684.
[21] Esposito G,Capoccia E,Gigli S,et al.HIV-1 Tat-induced diarrhea evokes an enteric glia-dependent neuroinflammatory response in the central nervous system[J].Sci Rep,2017,7(1):7735.
[22] 游仁芳,许福生,王少平.利多卡因对老年肺癌根治术患者围术期脑氧代谢及术后早期认知功能影响[J].临床军医杂志,2016,21(1):64-67.
[23] Zheng X,Chen L,Du X,et al.Effects of hyperbaric factors on lidocaine-induced apoptosis in spinal neurons and the role of p38 mitogen-activated protein kinase in rats with diabetic neuropathic pain[J].Exp Ther Med,2017,13(6):2855-2861.
[24] Otis C,Guillot M,Moreau M,et al.Spinal neuropeptide modulation,functional assessment and cartilage lesions in a monosodium iodoacetate rat model of osteoarthritis[J].Neuropeptides,2017,10(65):56-62.
[25] 曲晓云,葛友娥.创伤性颈胸段脊髓损伤减压手术的麻醉处理研究[J].中国实用医药,2016,2(01):152-153.
[26] Dai Z,Huang C,Zhao Q,et al.Effects of extrinsic cardiac nerve stimulation on atrial fibrillation inducibility: the regulatory role of the spinal cord[J].J Cardiovasc Electrophysiol,2017,28(7):819-827.
[27] 党培业,杨智泉,王彦东,等.帕瑞昔布钠联合利多卡因在腰椎开放性手术围手术期镇痛中的疗效观察[J].中华全科医学,2017,15(3):371-374.
[28] Cheng KI,Wang HC,Wu YC,et al.Sciatic nerve intra-fascicular lidocaine injection-induced peripheral neuropathic pain: alleviation by systemic minocycline administration[J].Clin J Pain,2015,8(3):114-116.
[29] Hagen EM,Rekand T.Management of neuropathic pain associated with spinal cord injury[J].Pain Ther,2015,4(1):51-55.
[30] 徐海平,赵柏松,佘应军,等.右美托咪定对利多卡因诱发大鼠脊髓神经毒性时BDNF表达的影响[J].中华麻醉学杂志,2016,36(10):1197-1201.
[31] Kumar R,Prasoon P,Gautam M,et al.Comparative antinociceptive effect of arachidonylcyclopropylamide,a cannabinoid 1 receptor agonist & lignocaine,a local anaesthetic agent,following direct intrawound administration in rats[J].Indian J Med Res,2016,144(5):730-740.
[32] 梁东科,张炳东,王丰.复方利多卡因乳膏和艾司洛尔对老年患者双腔支气管插管围插管期应激反应的影响[J].中国老年学杂志,2016,36(4):907-909.
[33] David-Pereira A,Sagalajev B,Wei H,et al.The medullary dorsal reticular nucleus as a relay for descending pronociception induced by the mGluR5 in the rat infralimbic cortex[J].Neuroscience,2017,349:341-354.
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