利多卡因在体外循环心脏不停跳二尖瓣置换术中的心肌保护效果

doi:10.3969/j.issn.1006-5725.2026.03.009

Abstract

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

CLC Number:

Fuxing QIN,Chunying ZHANG,Mingyuan ZHAO,Zehan HUANG. The analysis of the myocardial protective effect of lidocaine in intraoperative circulatory arrest during beating heart mitral valve replacement surgery[J]. The Journal of Practical Medicine, 2026, 42(3): 425-431.

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References 25

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一般资料	B组（n = 25）	A组（n = 25）	t/χ²值	P值
年龄（x ± s）/岁	52.1 ± 11.8	49.3 ± 11.6	0.859	0.729
性别/［例（%）］			0.080	1.000
男	12	13
女	13	12
身高（x ± s）/cm	158.0 ± 8.7	158.0 ± 8.0	0.186	0.737
体质量（x ± s）/kg	53.2 ± 11.4	53.6 ± 8.4	-0.134	0.153
ASA分级/例			0.660	0.512
Ⅰ级	6	7
Ⅱ级	15	16
Ⅲ级	4	2

一般资料	B组（n = 25）	A组（n = 25）	Z/t值	P值
手术时间［M（IQR）］/min	297.0（110.0）	260.0（60.0）	-2.545	0.011
麻醉时间［M（IQR）］/min	355.0（121.0）	325.0（43.0）	-2.700	0.007
体外循环时间［M（IQR）］/min	132.0（95.0）	105.0（49.0）	-2.950	0.003
左心室前后径（x ± s）/mm	49.3 ± 8.5	54.3 ± 12.2	-1.698	0.097
左心室EF值（x ± s）/%	59.5 ± 13.4	59.3 ± 12.1	0.044	0.965

因变量	自变量	B值（非标准化系数）	标准化系数（Beta）	t值	P值	95%CI
T₁ TNT-HS	（常量）	2.44	/	6.36	< 0.05	1.66 ~ 3.21
	组别	-0.73	-0.69	-5.57	< 0.05	-0.99 ~ -0.46
	手术时间	-0.00	-0.28	-0.75	0.46	-0.01 ~ 0.00
	麻醉时间	-0.00	-0.14	-0.35	0.73	-0.01 ~ 0.00
	体外循环时间	0.00	0.02	0.08	0.94	-0.01 ~ 0.01
T₂ TNT-HS	（常量）	1.82	/	3.48	< 0.05	0.77 ~ 2.88
	组别	-0.76	-0.60	-4.23	< 0.05	-1.12 ~ -0.40
	手术时间	-0.00	-0.08	-0.17	0.86	-0.01 ~ 0.01
	麻醉时间	0.00	0.16	0.37	0.71	-0.01 ~ 0.01
	体外循环时间	-0.00	-0.41	-1.42	0.16	-0.01 ~ 0.00

指标	B组（n = 25）	A组（n = 25）	Z值	P值
TNT-HS/（ng/mL）
T₀	0.011（0.018）	0.013（0.012）	-0.039	0.969
T₁	1.220（0.996）^#	0.777（0.342）^#	-3.842	< 0.001
T₂	1.250（1.008）^#	0.768（0.622）^#	-2.775	0.006
MYO/（ng/mL）
T₀	21.0（12.5）	21.0（11.3）	-0.041	0.967
T₁	765.0（673.6）^#	375.0（285.9）^#	-3.172	0.002
T₂	359.2（362.1）^#	214.5（126.7）^#	-2.668	0.008
CK/（U/L）
T₀	68.0（50.0）	47.0（28.0）	-2.513	0.012
T₁	1 105.0（1 258.0）^#	623.0（240.0）^#	-2.590	0.010
T₂	1 142.0（1 255.0）^#	632.0（406.0）^#	-2.755	0.006
CK-MB/（U/L）
T₀	13.5（12.3）	13.5（6.0）	-1.116	0.264
T₁	117.6（43.3）^#	87.9（27.7）^#	-3.541	< 0.001
T₂	62.0（32.4）^#	44.5（24.0）^#	-2.581	0.010

指标	B组（n = 25）	A组（n = 25）	t值	P值
HR/（次/min）
M₀	85.1 ± 7.8	86.2 ± 7.3	-5.507	0.615
M₁	102.0 ± 11.0^#	88.8 ± 6.2	5.257	< 0.001
M₂	107.3 ± 6.6^#	96.5 ± 5.5^#*	6.299	< 0.001
MAP/mmHg
M₀	86.7 ± 11.8	86.5 ± 10.8	0.071	0.944
M₁	73.0 ± 5.5^#	80.8 ± 6.7^#	-4.537	< 0.001
M₂	96.1 ± 7.5^#*	82.8 ± 6.4	6.751	< 0.001

The analysis of the myocardial protective effect of lidocaine in intraoperative circulatory arrest during beating heart mitral valve replacement surgery

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