利多卡因对中心静脉置管相关性血栓形成预防的影响
摘要
目的评价利多卡因对中心静脉置管相关性血栓形成预防效果的影响。方法择期需中心静脉置管全麻手术患者150例,性别不限,年龄37-75岁,体重55-70kg,ASA分级Ⅱ级,采用随机数字表法随机分为2组(n=75):利多卡因组(L组)和对照组(C组)。采用超声引导下中心静脉穿刺置管术。L组经中心静脉持续靶控输注利多卡因直到手术结束,利多卡因目标血浆靶浓度为2μg/ml,C组持续静脉输注等量的生理盐水直到手术结束。分别于中心静脉置管后第1d(T1)、第3d(T2)、第5d(T3)、第7d(T4)经中心静脉采血检测D-二聚体(DD)含量、全血粘度及红细胞聚集指数,采用多普勒超声检测中心静脉血栓发生情况。结果与C组比较,L组血栓发生率明显降低(P<0.05);与C组比较,L组T1-2时静脉血D二聚体含量、全血粘度、红细胞聚集指数无明显变化,差异无统计学意义(P>0.05),T3-4时静脉血D二聚体含量、全血粘度、红细胞聚集指数明显降低(P<0.05)。结论利多卡因可降低静脉血D-二聚体含量、全血粘度、红细胞聚集指数,降低中心静脉置管相关性血栓的发生,有效预防中心静脉置管相关性血栓形成。
引文
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[8]陶安宇,曾智琳,陆雅静.彩色多普勒超声在诊断颈内静脉置管后血栓形成及评价溶栓疗效中的应用价值[J].临床医药文献电子杂志,2016,3(10):1946-1947.
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[2]Fletcher JJ,Stetler W,Wilson TJ,et a1.The clinical signifi-canoe of peripherally inserted central venous catheter-related deep vein thrombosis[J].Neurocritical Care,2011,15(3):134-137.
[3]温玉玲.外周静脉穿刺中心静脉置管血栓形成的相关因素及护理措施[J].江西医药,2017,52(5):450-452.
[4]Kearon C,Akl EA,Comerota AJ,et,al.Antithrombotic therapy for VET disease:Antithrombotic therapy and Preventin of Throm-bosis,9th ed:American College of Chest Physicians Evidence-Based Clin-ical Practice Guidelines[J].Chest,2012,141(2Suppl):e419s-e496s.
[5]Granziera S,Cohen AT.VTE primary prevention,includic surgical patients[J].Thromb Hae-most,2015,113(6):1216-1223.
[6]饶文康,王洁萍,胡迎.超声观察临床治疗外科患者下肢深静脉血栓形成的研究[J].江西医药,2008,43(11):1225-1226.
[7]李志莲,余永森,杨莉,谢琦.中心静脉置管术后静脉血栓形成的超声诊断及相关因素分析[J].中华诊断学电子杂志,2017,5(03):179-182.
[8]陶安宇,曾智琳,陆雅静.彩色多普勒超声在诊断颈内静脉置管后血栓形成及评价溶栓疗效中的应用价值[J].临床医药文献电子杂志,2016,3(10):1946-1947.
[9]杨明敏,张奇芬,陶晓三.地塞米松与左布比卡因、利多卡因在臂丛神经阻滞中的应用[J].江西医药,2016,51(1):72-74.
[10]Piegeler T,Votta-Velis EG,Bakhshi FR,et al.Endothelial barrier protection by local anesthetics:ropivacaine and lidocaine block tumor necrosis factor-alpha-induced endothelial cell Src activation[J].Anesthesiology,2014,120(6):1414-1428.
[11]Koch C A.A Novel Approach for Preventing the Development of Persistent Vasospasms after Microsurgery for the Extremities:Intermittent Topical Lidocaine Application[J].Reconstructive Microsurgery,2010,26(2):79-85.