Lwm Txoj Kev Siv Lidocaine
Lidocainepaub tias yog ib qho ntawm feem ntau siv tshuaj loog hauv zos. Tab sis dab tsi ntau tus neeg yuav tsis paub yog tias lidocaine, ua tshuaj loog, kuj muaj ntau yam tsis muaj tshuaj loog, uas yog qhov zoo heev. Lidocaine ntxiv rau cov nyhuv tshuaj loog, nws cov nyhuv tsis yog tshuaj loog kuj tseem muaj txiaj ntsig ntawm daim ntawv thov ntau dua, muaj kev cia siab rau daim ntawv thov, yog li nws tsim nyog rau peb mus kawm ntxiv, nthuav dav ntxiv rau daim ntawv thov ntawm lidocaine thiab lwm yam tshuaj loog hauv zos.
Cov tshuaj loog hauv zos lidoca, raws li sodium channel blocker, muaj cov membrane ruaj khov thiab siv tawm tsam ventricular arrhythmias. Nyob rau hauv xyoo tas los no, nrog kev sib sib zog nqus ntawm kev tshawb fawb tshuaj thiab kev kho mob ntawm lidocaine muaj kev tswj hwm kev ua haujlwm ntawm lub cev tiv thaiv kab mob thiab ua si los tiv thaiv kev mob tshwm sim hauv cov tshuaj tiv thaiv kab mob ntawm ntau qhov sib txuas, qhov tseem ceeb inhibiting inflammatory cov tshuaj tiv thaiv thiab mob ntsws mob, cov nyhuv rhiab heev. ntawm cov tshuaj tiv thaiv kab mob qog noj ntshav, tshuaj tua kab mob, tiv thaiv lub hlwb thiab txo qis kev paub txog kev paub tsis meej (POCD), thiab lwm yam ntawm lub luag haujlwm yog cov kws tshawb fawb soj ntsuam.
1. Antibacterial kev ua haujlwm ntawm lidocaine
Cov tshuaj tua kab mob ntawm cov tshuaj loog hauv zos tau tshaj tawm thawj zaug hauv 1909. Los ntawm kev kawm ntawm 1200 kuaj kab mob kab mob, qee cov kws tshawb fawb pom tias lidocaine muaj ntau qib ntawm inhibition ntawm staphylococcus aureus, Escherichia coli thiab lwm cov kab mob pathogenic thiab cov kab mob sib cais, thiab tus nqi inhibition nce nrog cov kab mob. nce cov tshuaj loog hauv zos concentration, uas tuaj yeem tiv thaiv ntau yam kab mob hauv tsev kho mob. Qee cov kev tshawb fawb tau pom tias lidocaine thiab bupivacaine muaj cov nyhuv bacteriostatic tseem ceeb ntawm cov tshuaj kho mob ntau (0.5 feem pua ~ 1.0 feem pua lidocaine thiab 0.125 feem pua ~ 0.25 feem pua bupivacaine), thiab cov nyhuv bacteriostatic nyhav. nce nrog nce concentration. Tsis tas li ntawd, 1 feem pua lidocaine tau muaj zog tiv thaiv kab mob ntau dua li 0.125 feem pua bupivacaine. Nws tau raug tshaj tawm tias lidocaine inhibits adhesion thiab chemotaxis ntawm granulocytes thiab muaj cytotoxicity.
Cov kev tshawb fawb tau pom tias cov tshuaj loog hauv zos inhibit cell loj hlob ntawm EScherichia coli, ua rau kom tawm ntawm cov ntsiab lus ntawm tes thiab cuam tshuam nrog kev ua pa. Hauv kev xaus, lidocaine muaj kev nyab xeeb thiab muaj peev xwm tiv thaiv kev loj hlob ntawm cov kab mob hauv thaj chaw epidural thiab catheter thaum lub sij hawm tshuaj loog epidural los yog lub sij hawm ntev tom qab kev ua haujlwm analgesia. Cov txheej txheem ntawm cov tshuaj tua kab mob ntawm cov tshuaj loog hauv zos xws li lidocaine tseem tsis paub meej. Nws yog qhov ua tau tias kev sib cuam tshuam ntawm cov tshuaj loog hauv zos thiab macromolecules nyob rau saum npoo ntawm cov kab mob los yog cov cell membranes cuam tshuam nrog eukaryotic thiab prokaryotic cell membranes, hloov kev ua haujlwm ntawm cell membranes, thiab ua rau kev tuag lossis kev loj hlob inhibition ntawm cov kab mob.
2. Lub hlwb tiv thaiv lidocaine
Lidocaine tuaj yeem yooj yim hla cov ntshav-hlwb barrier thiab muaj cov membrane stability. Raws li ib txwm muaj lub cev muaj zog, qhov concentration ntawm ion sab hauv thiab sab nraud ntawm tes yog qhov tsis tu ncua, thiab qhov txawv txav ion tam sim no tuaj yeem tshwm sim hauv hlwb hlwb thaum ntxov ntawm ischemia thiab hypoxia. Cov kev tshawb fawb tau pom tias lidocaine muaj qee yam kev tiv thaiv ntawm lub hlwb. Nws tau txiav txim siab tias lidocaine tuaj yeem tsis tsuas yog cog lus ncaj qha rau cov hlab ntsha loj hauv lub hlwb thiab tag nrho lub cev, tab sis kuj ua rau lub paj hlwb microvessels ntawm qhov chaw raug mob. Kev cog lus ntawm intracranial cov hlab ntsha loj tuaj yeem txo qis intracranial siab sai, thiab kev kho mob ntawm microcirculation spasm hauv thaj chaw focal tuaj yeem txhim kho cov ntshav ntawm ischemic hlwb cov ntaub so ntswg yam tsis muaj kev xav tias "nyem ntshav".
Cov kev tshawb fawb tau pom tias kev ua haujlwm lidocaine hauv cov neeg mob uas muaj cov qog nqaij hlav supratentorial tuaj yeem txo qis cov pa oxygen metabolism hauv lub hlwb, txo qis anaerobic glycolysis, tswj cov ntshav qabzib hauv cov ntshav, tsis txhob ncua sijhawm rov qab ua haujlwm, ua lub luag haujlwm hauv kev tiv thaiv lub hlwb, thiab tuaj yeem siv tau zoo hauv kev phais hlwb. Cov kev tshawb fawb saum toj no tau pom tias lidocaine muaj kev tiv thaiv rau lub hlwb, thiab nws cov txheej txheem yuav yog los ntawm kev thaiv Na plus, K ntxiv thiab Ca2 ntxiv cov channel, txo qis intracellular Na plus thiab Ca2 ntxiv concentration, txo qis ATP noj, tiv thaiv hypoxic paj hlwb, txo. K ntxiv tawm, inhibiting tso tawm excitatory amino acids thiab oxygen dawb radicals, thiab alleviating paj hlwb puas. Txhim kho cerebral ntshav khiav thiab ua lub luag haujlwm tiv thaiv hauv hlwb.
3. Anti-arrhythmic nyhuv ntawm lidocaine
Lidocaine muaj broad-spectrum anti-arrhythmic effect. ventricular arrhythmias muaj xws li ventricular premature systole, ventricular tachycardia, ventricular flutter thiab ventricular fibrillation. Qhov thib peb tom kawg yog hu ua malignant arrhythmias, uas yog ib qho ntawm cov kev pheej hmoo ywj pheej rau kev tuag sai sai. Malignant ventricular arrhythmias feem ntau ua rau hemodynamic deterioration, accelerate tus kab mob, thiab txawm muaj kev phom sij rau lub neej.
Vim hais tias ntawm IB chav kawm ntawm cov tshuaj antiarrhythmic, lidoca xaiv ua rau purkinje fibrocytes thiab ventricular myocytes, uas tuaj yeem ua rau qeeb ntawm 4-theem depolarization tus nqi, txo purkinje fibroself-kev qhuab qhia, txhawb K ntxiv tawm thiab ua kom lub sijhawm ua haujlwm ntev, thiab kuj prolong lub sij hawm zoo refractory. Nws yog feem ntau siv rau kev tiv thaiv thiab kev kho mob ntawm ventricular arrhythmia. Lidocaine tuaj yeem ua rau txo qis kev ua haujlwm ntawm lub plawv, inhibit cardiac contractility thiab txo cov suab paj nruag. Lidocaine tau siv rau hauv kev kho mob los tiv thaiv arrhythmia ntev thiab muaj kev paub ntau dua. Nyob rau hauv lub ntsej muag ntawm ventricular arrhythmia, cov kws kho mob feem ntau xaiv lidocaine rau kev tswj, uas muaj kev ua tau zoo thiab kev nyab xeeb.
4. Lidocaine tuaj yeem tiv thaiv kev mob ntau dhau
Ntau cov kev tshawb fawb tau pom tias lidocaine muaj txiaj ntsig zoo hauv kev tiv thaiv thiab tswj kev raug mob lossis endotoxin-induced inflammatory reactions. Lidocaine yog ib daim nyias nyias stabilizer uas inhibits adhesion thiab aggregation ntawm neutrophils (PMN), txo qhov tso tawm ntawm oxygen dawb radicals thiab proteolytic enzymes, stabilizes cell membranes, tswj cytokines, thiab inhibits ntau inflammatory teb. Inflammatory mediators LB4 thiab INTERleukin 1 (IL-1) yog PMN chemoattractants muaj zog, inducing PMN khi, desorption, exudation, superoxide tiam, thiab synergistic nrog prostaglanin E2 kom vascular permeability.
Nrog mononuclear hlwb hauv vitro nrog ntau qhov sib txawv (2 ~ 20 mol / L) lidocaine tuaj yeem cuam tshuam LB4 incubation, IL - 1 alpha tso tawm, mole ntawm lidocaine concentration tuaj yeem cuam tshuam cov qe ntshav dawb, mast cells, basophils tso tawm. histamine, uas lidocaine tuaj yeem cuam tshuam qee qhov tseem ceeb ntawm kev tso tawm cov tshuaj tiv thaiv kab mob thiab cov tshuaj tiv thaiv.
Hauv daim ntawv thov kev kho mob, ntau cov kev tshawb fawb tau pom tias cov tshuaj intraoperative intravenous infusion ntawm lidocaine tuaj yeem tswj hwm kev tiv thaiv kab mob ntawm cov neeg mob thiab ua kom lawv rov qab ua haujlwm tom qab. Herroeder yog sib npaug rau intraoperative lidocaine infusion nyob rau hauv cov neeg mob uas raug kev phais mob plab. Cov txiaj ntsig tau pom tias cov tshuaj lidocaine infusion ntawm perioperative intravenous infusion tuaj yeem ua kom rov qab ua kom lub plab zom mov ua haujlwm tau zoo thiab txo qhov ntev ntawm kev nyob hauv tsev kho mob. Lub caij no, cov tshuaj lidocaine infusion tuaj yeem txo qhov kev qhia theem ntawm IL-6, IL-8, ntxiv rau C3a, CD-11b, thiab lwm yam. Cov txheej txheem yuav yog cov tshuaj tiv thaiv kab mob ntawm lidocaine. ntawm kev phais mob.
Nws tau raug tshaj tawm tias nyob rau hauv qhov kev cia siab randomized ob qhov muag tsis pom kev sim, kev txhaj tshuaj lidocaine infusion tau muab rau cov neeg mob laparoscopic sab nraud, thiab nws tau pom tias qhov kev rov ua haujlwm tom qab ntawm cov neeg mob hauv pab pawg lidocaine tau txhim kho zoo, thiab tso cov lidocaine infusion. tuaj yeem txo qhov ntev ntawm kev nyob hauv tsev kho mob, thiab cov koob tshuaj opioid ntawm cov neeg mob kuj tau txo qis. Hauv cov txheej txheem ntawm PCIA, muaj teeb meem xws li phlebitis. Ntxiv lidocaine rau hauv cov tshuaj tua kab mob hauv cov hlab ntsha tuaj yeem tiv thaiv qhov tshwm sim ntawm phlebitis.
Tej zaum nws yuav yog lidocaine ua rau vascular endothelial hlwb thiab peripheral paj hlwb receptors nyob ze ntawm qhov chaw ntawm cov hlab ntsha, uas ua rau cov hlab ntsha thiab inhibits stimulation ntawm venous phab ntsa rau trocar thiab tso tawm ntawm inflammatory yam ntawm vascular endothelial hlwb. Cov hlab ntsha dilated ua kom cov ntshav khiav thiab tiv thaiv platelets los ntawm kev sib sau ua ke, yog li tiv thaiv kev tsim ntawm microthrombus thiab phlebitis. Cov kws khomob-induced phlebitis feem ntau tshwm sim hauv tsev kho mob. Cov kev tshawb fawb tau pom tias kev txhaj tshuaj ntawm cov tshuaj lidocaine qis dua li dexamethasone muaj txiaj ntsig zoo hauv kev tiv thaiv kev kho mob phlebitis.
Txawm li cas los xij, perioperative me me ntawm lidocaine txhaj tshuaj tuaj yeem txo qis kev ua haujlwm los ntawm kev mob, txo qhov kev phais, ib hom tshuaj loog hauv zos amide chav kawm, kev tshawb fawb tau pom tias nws muaj cov teebmeem tiv thaiv, thiab perioperative intravenous lidocaine tuaj yeem txo qhov mob tom qab, txo kev siv tshuaj opioid, txo lub cev cov lus teb inflammatory, ua kom lub plab zom mov ua haujlwm rov qab thiab ua kom lub sijhawm pw hauv tsev kho mob luv. Kev kawm ntxiv txog kev tiv thaiv thiab cov txheej txheem ntawm lidocaine ntawm kev tiv thaiv kev ua haujlwm tsis zoo los ntawm kev phais mob tuaj yeem muab lub hauv paus tshiab rau kev siv lidocaine hauv kev kho mob tshuaj tiv thaiv.
5. Kev siv lidocaine hauv kev mob ntsws mob
Mob ntsws raug mob (ALI) yog kev raug mob ntawm alveolar epithelium thiab vascular endothelial hlwb tshwm sim los ntawm inflammatory tshua nyob rau hauv lub ntsws los ntawm ntau yam lwm yam tsis yog cardiogenic. Nws cov txheej txheem pathogenic yog qhov qhia txog ntau dhau thiab tswj tsis tau cov kab mob hauv lub ntsws. Lub hauv paus pathophysiology yog ib qho kev tiv thaiv kab mob uas tsis muaj peev xwm ua rau muaj kev cuam tshuam ntawm PMN thiab pulmonary microvascular puas. Nyob rau hauv ib txwm muaj xwm txheej, PMN exudation thiab tshem tawm cov ntaub so ntswg necrotic yog ib qho lus teb ntawm lub cev los tiv thaiv kev tawm tsam txawv teb chaws. Raws li kev tswj hwm ntawm lub cev, cov lus teb inflammatory yog txwv rau cov cheeb tsam hauv zos, tab sis thaum tus kab mob loj heev, cov txheej txheem tswj tau raug rhuav tshem, thiab PMN ua kom tsis muaj zog, ua rau muaj kev nthuav dav ntawm cov lus teb inflammatory.
Ntau qhov kev tshawb fawb sim tau lees paub tias lidocaine tuaj yeem cuam tshuam cov lus teb ntawm PMN thiab txo qis kev mob ntsws mob los ntawm ntau yam ua rau. Hauv cov qauv kev raug mob ntawm lub ntsws, cov tshuaj lidocaine pretreatment intravenously txhim kho txoj kev ua pa, oxygenation, pulmonary vascular permeability, histopathological hloov, thiab biochemical hloov ntawm alveolar lavage kua piv nrog cov neeg mob tsis kho. Hauv kev xaus, lidocaine tuaj yeem txhim kho cov cell membrane, ua rau PMN, koom nrog txhua qhov kev sib txuas ntawm cov tshuaj tiv thaiv kab mob, inhibit PMN tsiv teb tsaws rau cov ntaub so ntswg raug mob, metabolism thiab adhesion rau endothelial hlwb, yog li txo ntau yam ua rau.
