关键词:

体外循环,  , 心脏瓣膜置换术,  , 谵妄,  , 利多卡因

Abstract:

Objective To assess the effect of lidocaine，administrated at the beginning of cardiopulmo⁃ nary bypass（CPB）and rewarming，on postoperative delirium after cardiac valve replacement；to explore the rela⁃ tionship between the effect and regional cerebral oxygen saturation（rSO2）. Methods 60 patients aged 34 ~ 75 years old，males or femals，scheduled for mitral valve replacement，with American Society of Anesthesiologists（ASA） physical status Ⅱ or Ⅲ，were enrolled in the current study. Participants were randomized assigned into 2 groups （n = 30 each）：2% lidocaine 4mg/kg was administrated to participants of group A at the beginning and rewarming of CPB，while same amount of normal saline was administrated to participants of group B. The incidence of postop⁃ erative delirium was assessed by Confusion Assessment Method for Intensive Care Unit（CAM⁃ICU）. Bilateral rSO2 was collected consecutively throughout the course of the operation，the baseline，mean，minimum of rSO2 and the percentage of rSO2 decrease from baseline to minimum were calculated. The extubation time，the adverse reactions， the durations of ICU stay ，the dosage of sedative and analgesic drugs and hospitalization were recorded. Results Compared with group B，the percentage of rSO2 decrease from baseline to minimum was significantly decreased， the minimal rSO2 was significantly increased，the incidence of postoperative delirium was significantly decreased， the extubation time and duration of ICU stay were significantly shortened，and the dosage of sufentanil was signifi⁃ cantly decreased after operation in group A（P < 0.05）. There were no significant difference in other results（P > 0.05）. Conclusions Administrating lidocaine at the beginning and rewarming of CPB can reduce the incidence of delirium after mitral valve replacement，shorten the extubation time and duration of ICU stay，and decrease the dosage of sufentainil after operation，which may be related to the improvement of intraoperative rSO2.

Key words:

cardiopulmonary bypass, cardiac valve replacement, delirium, lidocaine