摘要
目的:探讨术中静脉输注利多卡因对腹腔镜全子宫切除术中麻醉药物用量及术后镇痛效果的影响。方法:选取2019年1-12月于本院择期行腹腔镜全子宫切除术患者60例。采用随机数字表法将患者分为利多卡因试验组(L组)和生理盐水空白对照组(C组),每组30例。L组麻醉诱导时缓慢静脉注射利多卡因1.5 mg/kg,继之以2 mg/(kg·h)的速度持续泵注至手术结束;C组诱导时及术中维持静脉输注等量生理盐水。两组均采用丙泊酚、舒芬太尼、罗库溴铵全凭静脉麻醉,术后镇痛采用舒芬太尼静脉自控镇痛(PCIA)。记录两组患者插管前后及拔管前后即刻心率变化(ΔHR)、平均动脉压变化(ΔMAP);记录两组患者术中丙泊酚、瑞芬太尼维持总量;记录两组患者拔管即刻(T0)、拔管后1 h(T1)、拔管后2 h(T2)、拔管后6 h(T3)、拔管后24 h(T4)各时间点的静息及运动疼痛视觉模拟(VSA)评分;记录两组患者24 h镇痛泵舒芬太尼使用量及术后恶心呕吐(PONV)评分。结果:L组插管及拔管前后的ΔHR、ΔMAP均明显小于C组,L组术中丙泊酚、瑞芬太尼维持总量及24 h镇痛泵舒芬太尼使用总量均明显小于C组,差异均有统计学意义(P<0.05)。L组术后T0、T3时间点静态VAS评分及术后T0、T1时间点动态VAS评分均明显低于C组,差异均有统计学意义(P<0.05)。L组PONV评分低于C组,差异有统计学意义(P<0.05)。结论:静脉输注利多卡因可减小腹腔镜全子宫切除术患者麻醉插管及拔管时的血流动力学波动,减少麻醉药物用量减轻术后不良反应。
Objective:To investigate the effect of intraoperative intravenous infusion of Lidocaine on the dosage of narcotic drugs and postoperative analgesia in laparoscopic total hysterectomy.Method:A total of 60 patients undergoing elective laparoscopic total hysterectomy in our hospital from January to December 2019 were selected.The patients were divided into Lidocaine test group (group L) and normal Saline blank control group (group C) by random number table method,with 30 patients in each group.During anesthesia induction,1.5 mg/kgLidocaine was slowly injected intravenously in group L,followed by 2 mg/(kg·h) continuous pumping until the end of the operation.Intravenous infusion of the same amount of normal Saline was maintained during induction and operation in group C.Propofol,Sufentanil and Rocuronium were used for both groups under intravenous anesthesia,and Sufentanil intravenous controlled analgesia (PCIA) was used for postoperative analgesia.The changes of heart rate before and after intubation and extubation (ΔHR) and mean arterial pressure (ΔMAP) were recorded.The total maintenance amount of Propofol and Remifentanil in the two groups were recorded.Visual analogue scale (VAS) scores of rest and exercise pain were recorded in the two groups at each time point immediately after extubation (T0),1 h (T1),2 h (T2),6 h (T3),and 24 h (T4) after extubation.The use of Sufentanil analgesia pump and postoperative nausea and vomiting (PONV) score were recorded in the two groups.Result:The ΔHR and ΔMAP of group L before and after intubation and extubation were significantly smaller than those of group C,and the total amount of Propofol,Remifentanil maintenance and the total amount of Sufentanil use in analgesia pump of group L were significantly smaller than those of group C,with statistically significant differences (P<0.05).Static VAS scores at time points of T0 and T3 and dynamic VAS scores at time points of T0 and T1 in group L were significantly lower than those in group C,the differences were statistically significant (P<0.05).PONV score of group L was lower than that of group C,the difference was statistically significant (P<0.05).Conclusion:Intravenous lidocaine can reduce the hemodynamic fluctuation during anesthesia intubation and extubation in patients with laparoscopic total hysterectomy,reduce the amount of anesthetic drugs,and reduce postoperative adverse reactions.
作者
张龙新
陈婵娟
周敏
ZHANG Longxin;CHEN Chanjuan;ZHOU Min(Fujian Provincial Maternity and Children’s Hospital,Fuzhou 350001,China;不详)
出处
《中国医学创新》
CAS
2020年第32期42-45,共4页
Medical Innovation of China
