【摘要】 目的 探讨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及其临床应用价值。方法 选择2023年1月至2025年9月接受体外循环心脏不停跳二尖瓣置换术的患者50例，随机分为两组：A组（利多卡因+不停跳组）、B组（仅不停跳组）。两组患者全身麻醉诱导和麻醉维持方案相同，但A组使用心脏不停跳手术技术并在麻醉诱导前10 min静脉泵注利多卡因1.5 mg/kg，然后以1.5 mg/（kg·h）的速度持续泵注至手术结束，B组仅使用心脏不停跳手术技术。记录术前（T₀）、术后6 h（T₁）、术后12 h（T₂）血浆的超敏心肌肌钙蛋白T（TNT-HS）、肌红蛋白（MYO）、肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）浓度。结果 与B组比较，A组在T₁和T₂的血浆TNT-HS、MYO、CK和CK-MB浓度降低，差异有统计学意义（P<0.05）。与T₀比较，A组、B组在T₁和T₂的血浆TNT-HS、MYO、CK、CK-MB浓度均升高，差异有统计学意义（P<0.05）。结论 利多卡因在体外循环心脏不停跳二尖瓣置换术中具有显著的心肌保护作用，且能够有效抑制气管插管时血流动力学的波动，减少围术期室性心律失常的发生。更多还原

【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.更多还原