目的 探討靜脈輸注利多卡因?qū)π屑怪中g的老年患者術后炎癥免疫反應及認知功能的影響。方法 選擇2015年1月—2016年1月在寶雞市中心醫(yī)院行脊柱手術的老年患者80例，隨機分為兩組，每組40例，對照組患者接受常規(guī)全麻，實驗組患者在對照組基礎上靜脈輸注利多卡因負荷量1 mg/kg，維持量為1.5 mg/kg直至手術結束。比較兩組患者術前術后的MMSE評分以及術后認知功能障礙（POCD）的發(fā)生情況，檢測兩組患者術前術后免疫炎癥因子的表達水平并對其進行統(tǒng)計學分析。結果 實驗組患者術后3 d的MMSE評分顯著低于對照組，差異有統(tǒng)計學意義（P<0.05）；實驗組POCD的發(fā)生率顯著低于對照組，差異有統(tǒng)計學意義（P<0.05）。實驗組患者術后7 d血清中IgA、IgM以及IgG的水平顯著高于對照組，差異有統(tǒng)計學意義（P<0.05）；在術后3 d及術后7 d，實驗組患者血清白介素-6（IL-6）水平顯著低于對照組，差異有統(tǒng)計學意義（P<0.05），但是兩組患者血清中腫瘤生長因子-α（TNF-α）的水平相當，差異無統(tǒng)計學意義。結論 老年患者行脊柱手術時，術中靜脈輸注利多卡因，可以有效抑制炎癥反應的發(fā)生，改善患者的免疫功能，降低患者術后發(fā)生POCD的發(fā)生率，值得臨床推薦應用。

Objective To explore the effect of lidocaine with intravenous infusion on the postoperative inflammatory factors and cognitive dysfunction for elderly patients undergoing spinal operation.Method 80 elderly patients undergoing spinal operation in Central hospital of Baoji were enrolled from January 2015 to January 2016, of which patients divided into two groups randomly, control group (n= 40) accepted routine general anesthesia, and study group (n= 40) adopted intravenous lidocaine based on the patients in control group, comparing the MMSE score and the incidence of postoperative cognitive dysfunction (POCD) with before operation, detecting and analyzing the difference of inflammatory and immunity factors.Results The MMSE score of the study group after three days of operation was significantly lower than that of the control group, the difference was statistically significant (P<0.05). The incidence of POCD in the study group was significantly lower than that in the control group, the difference was statistically significant (P<0.05). The serum levels of IgA, IgM and IgG in the study group after seven days of operation were significantly higher than those in the control group, the difference was statistically significant (P<0.05). After three days and seven days postoperatively, the serum levels of interleukin -6 (IL-6) in the study group were significantly lower than those in the control group, the difference was statistically significant (P<0.05). And there was no significance of TNF-α between two groups at any time point.Conclusions Intravenous lidocaine for patients undergoing spinal operation could inhibit the inflammatory response, improve the function of immunity, and decrease the incidence of POCD, which deserved popularization in clinic.