Abstract: Background　Postoperative pulmonary complication（PPC）is common after esophagectomy，which is closely related with intraoperative one-lung ventilation.PPC not only increases hospitalization expense，but also increases the unplanned readmission rate after discharge.Moreover，it is an independent risk factor for poor prognosis of esphagectomy patients.However，PPC control after esophagectomy remains unsatisfied.Objective　To evaluate whether intravenous infusion of lidocaine can produce lung protection effect through the anti-inflammatory mechanism in esophagectomy patients，so as to reduce the possibilities of having lung injury and PPC，and improve patients' prognosis.Methods　Sixty adult patients who underwent elective open radical esophagectomy from November 2017 to June 2018 in the Affiliated Hospital of Xuzhou Medical University were selected as the subjects.They were randomly and equally divided into two groups，lidocaine group（group L）and control group（group C）．Both groups were treated with the same anesthesia induction and maintenance regimens，the difference was that group L received a loading dose of 2% lidocaine 1.5 mg/kg injected intravenously within 5 minutes at 5 minutes before anesthesia induction（T0），and then infused intravenously at the rate of 1.5 mg?kg-1?h-1 continuously until 1 hour after the end of the operation，while group C received an equal volume of 0.9% normal saline via the same administration procedure.General data were collected.Blood samples were collected at T0，admission to ICU（T1），12h after surgery（T2）and 36 h after surgery（T3），respectively，and oxygenation index（OI），interleukin（IL）-6，WBC，C-reactive protein（CRP），surfactant protein-A（SP-A）were measured.Postoperative indices were also recorded.Results　Intervention method and time had interaction effect on OI，IL-6，WBC，CRP and SP-A（P<0.05）．Intervention method and time had significant main effects on OI，IL-6，WBC，CRP and SP-A，respectively（P<0.05）．At T1，T2 and T3，group L showed higher OI but lower WBC，CRP and SP-A compared with group C（P<0.05）．IL-6 in group L was lower than that in group C at T1（P<0.05）．In both groups，OI was lower at T1，T2 and T3 than at T0，while IL-6，WBC and CRP were higher than at T0（P<0.05）．SP-A was higher at T1，T2 and T3 than at T0 in group C（P<0.05）．SP-A was higher at T1 and T2 than at T0 in group L（P<0.05）．There were no significant differences in ventilation time in the ICU，ICU length of stay，postoperative length of stay，atelectasis rate，pulmonary infection rate，pleural effusion rate and reintubation rate between the two groups（P>0.05）．Group L needed shorter time to have first passage of flatus，first passage of stool，and first oral fluid intake after the surgery than group C（P<0.05）．There were no lidocaine-related adverse events，respiratory failure，bronchospasm，aspiration pneumonia and pneumothorax happened in either group.Conclusion　Perioperative intravenous infusion of lidocaine may reduce IL-6，WBC，CRP and SP-A，reduce pulmonary inflammatory response，alleviate lung injury and improve patients' OI after esphagectomy，showing certain pulmonary protective effect.

Key words: Esophageal neoplasms；Lidocaine；Infusions, intravenous；Lung injury；Lung protective effect

摘要： 背景　肺部并发症是食管癌术后常见的并发症，与术中使用单肺通气密切相关。其不仅增加患者的住院费用，还显著增加患者出院后的非计划性再入院率，并且是食管癌患者预后较差的独立危险因素。而目前对食管癌术后肺部并发症的控制仍然不尽人意。目的　评估围术期静脉滴注利多卡因能否通过抗炎作用对食管癌患者产生肺保护作用，以期减轻肺损伤，减少术后肺部并发症的发生，改善患者预后。方法　选择2017年11月—2018年6月在徐州医科大学附属医院行择期开放性食管癌根治术的成年患者60例为研究对象。按照随机数字表法将患者分为利多卡因组（L组，30例）和对照组（C组，30例）。L组于麻醉诱导前5 min予2%利多卡因1.5 mg/kg负荷剂量，于5 min内缓慢静脉注射，然后以1.5 mg?kg-1?h-1的速度持续泵注至术后1 h；C组以相同体积的0.9%氯化钠溶液静脉注射和持续泵注。所有患者采取相同的麻醉诱导方案。收集患者的一般资料，分别于患者麻醉诱导前5 min（T0）、入ICU时（T1）、术后12 h（T2）、术后36 h（T3）检测其氧合指数（OI）、白介素（IL）-6、白细胞计数（WBC）、C反应蛋白（CRP）、表面活性蛋白A（SP-A），记录术后指标。结果　干预方法与时间在OI、IL-6、WBC、CRP、SP-A上存在交互作用（P<0.05）；干预方法、时间在OI、IL-6、WBC、CRP、SP-A上主效应显著（P<0.05）。L组T1、T2、T3时OI高于C组，WBC、CRP、SP-A低于C组（P<0.05）；L组T1时IL-6低于C组（P<0.05）。C组、L组T1、T2、T3时OI低于本组T0时，IL-6、WBC、CRP高于本组T0时（P<0.05）；C组T1、T2、T3时SP-A高于本组T0时（P<0.05）；L组T1、T2时SP-A高于本组T0时（P<0.05）。两组ICU中呼吸机使用时间、ICU停留时间、术后住院时间、肺不张发生率、肺部感染发生率、胸腔积液发生率、二次插管发生率比较，差异无统计学意义（P>0.05）；L组第1次排气时间、第1次排便时间、经口进食流质饮食时间短于C组（P<0.05）；两组均无患者发生利多卡因相关不良事件、呼吸衰竭、支气管痉挛、吸入性肺炎、气胸。结论　围术期静脉滴注利多卡因可降低食管癌患者术后的IL-6、WBC、CRP、SP-A，减弱肺部炎性反应，减轻肺损伤，提高患者OI，有一定的肺保护作用。

关键词: 食管肿瘤；利多卡因；滴注, 静脉内；肺损伤；肺保护作用