关键词: 利多卡因, 心肌保护, 心脏不停跳, 二尖瓣置换, 体外循环

Abstract:

Objective To investigate the myocardial protective effects and clinical value of lidocaine in cardiopulmonary bypass （CPB） non-arrested （beating-heart） mitral valve replacement surgery. Methods A total of 50 patients who underwent CPB beating-heart mitral valve replacement between January 2023 and September 2025 were randomly divided into two groups： Group A （lidocaine + beating-heart group） and Group B （beating-heart only group）. The two groups received identical anesthesia induction and maintenance protocols. However， Group A additionally received an intravenous infusion of lidocaine at 1.5 mg/kg 10 minutes before anesthesia induction， followed by continuous infusion at a rate of 1.5 mg/（kg·h） until the end of surgery. Group B received only the beating-heart surgical technique without lidocaine. Plasma levels of high-sensitivity cardiac troponin T （TNT-HS）， myoglobin （MYO）， creatine kinase （CK）， and creatine kinase-MB （CK-MB） were measured preoperatively （T₀）， at 6 hours postoperatively （T₁）， and at 12 hours postoperatively （T₂）. Results Compared with Group B， Group A showed significantly lower plasma levels of TNT-HS， MYO， CK， and CK-MB at T₁ and T₂ （P < 0.05）. In both groups， these markers were significantly elevated at T₁ and T₂ compared with T₀ （P < 0.05）. Conclusion Lidocaine demonstrates significant myocardial protection during on-pump beating-heart mitral valve replacement surgery， effectively suppresses hemodynamic fluctuations during endotracheal intubation， and reduces the incidence of perioperative ventricular arrhythmias.

Key words: lidocaine, myocardial protection, beating-heart, mitral valve replacement, extracorporeal circulation