摘要：目的 探讨在冠状动脉移植术(CABG)中，开放升主动脉前一次性通过膜式氧合器的给药旁路注入100mg利多卡因是否有利于避免再灌注室颤。方法 将24例冠心病(CAD)患者随机分成2组：利多卡因组(L组)和对照组(C组)。L组12名患者于升主动脉开放前1min通过膜式氧合器的给药旁路给予100mg的利多卡因；C组给予5ml的生理盐水。通过Swan-Ganz导管监测全组病人麻醉诱导后以及脱离CPB后的血流动力学指标：心率(HR)、平均动脉压(MAP)、平均肺动脉压(MPAP)、肺毛细血管楔压(PCWP)、静脉压(CVP)以及心排量(CO)。结果 主动脉阻断时间和CPB时间无明显差异；(1)L组的再灌注室颤的发生率(17%)明显低于C组(58%)(P<0.05)。(2)两组患者应用血管活性药没有明显差异。(3)与C组比较L组在脱离CPB后心排量明显增加(P<0.01)。结论 在开放升主动脉时一次性通过膜式氧合器的给药旁路注入100mg利多卡因有利于防止再灌注室颤的发生；并且在患者脱离CPB后有利于维持一个较高的心排量。

    关键词：利多卡因；再灌注；心室纤颤；冠状动脉移植术

    Lidocaine in Prevention of the Reperfusion Ventricular Fibrillation in Patients Undergoing CABG

    JI Bing-yang, LIU Jin-ping, FENG Zheng-yi, YU Kun, LONG Cun

    (Department of Cardiopulmonary bypass, Cardiovascular Institute & Fuwai Hospital, PUMC & CAMS, Beijing 100037)

    Abstract: OBJECTIVE To investigate whether to infuse a bolus of lidocaine by way of the oxygenator before releasing the aortic cross-clamping could lower the incidence of reperfusion ventricular fibrillation during CABG.METHODS Twenty-four CAD patients were randomly divided into two groups：Lidocaine group (Group L n=12); control group (Group C n=12). 12 patients in group L received 100mg of lidocaine by way of oxygenator 1 minute before releasing the aortic cross-clamping(ACC),and 12 patients in group C received 5ml of saline. Blood dynamic indexes were monitored by the Swan-Ganz before induction and after weaning from cardiopulmonary bypass.RESULTS There were no difference of the aortic cross-clamping time and CPB time in both groups. (1) The rate of rebeating in group L is higher than group C (P<0.05). (2)And there is no difference in using inotropic drugs after operation. (3) Comparing with the group C, The CO of group L is much higher (P<0.05). CONCLUSION the results shows that a bolus of 100mg of lidocaine infused by way of oxygenator 1 minute before release of the ACC can decrease the incidence of reperfusion ventricular fibrillation and is related with better hemodynamics after weaning. ......