静脉泵注利多卡因对输尿管软镜碎石术患者术后镇痛及快速康复的影响

Effects of intravenous pumping of lidocaine on postoperative analgesia and rapid recovery of patients undergoing flexible ureteroscopic lithotripsy

目的探讨静脉泵注利多卡因对输尿管软镜碎石术(FURL)患者术后镇痛效果及快速康复的影响。方法该研究为前瞻性、三盲、随机对照试验。选取择期在全身麻醉下行FURL的患者64例,按随机数字表法分为2组(n=32):利多卡因组和对照组。利多卡因组患者在麻醉诱导时静脉泵注利多卡因负荷量1.5 mg·kg^(-1),泵注10 min,后以1.5 mg·kg^(-1)·h^(-1)速率泵注至手术结束;对照组以同样方式泵注同等容量生理盐水。喉罩插管后全凭静脉麻醉下术中脑电双频指数(BIS)维持在40~50。评估并记录2组患者拔除喉罩后15 min、术后2、6、12、24、48和72 h视觉模拟评分法(VAS)评分;记录术中丙泊酚、瑞芬太尼用量、术后VAS≥4分时补救镇痛(芬太尼50μg)次数、患者苏醒时间、PACU停留时间、术后首次肠道排气时间、下床活动时间、术后住院时间、术后恶心呕吐(PONV)及有关不良反应的发生情况。结果与对照组比较,利多卡因组拔除喉罩后15 min、术后2、6、12、24、48 h VAS评分明显降低(P<0.05),而术后72 h,2组间VAS评分差异无统计学意义(P>0.05)。利多卡因组术中丙泊酚、瑞芬太尼用量、补救镇痛次数较对照组减少(P<0.05);苏醒时间、PACU停留时间、术后肠道首次排气时间、下床活动时间、术后住院时间均早于对照组(P<0.05);PONV发生率较对照组低(P<0.05)。2组均未发生相关不良反应。结论静脉泵注利多卡因可安全、有效缓解FURL术后疼痛,对患者术后快速康复具有积极作用。

AIM To investigate the effects of intravenous pumping of lidocaine on postoperative analgesia and rapid recovery of patients undergoing flexible ureteroscopic lithotripsy(FURL).METHODS This was a prospective,triple-blind,randomized controlled trial.A total of 64 patients undergoing FURL under general anesthesia were selected and divided into lidocaine group(group L)and control group(group C),with 32 patients in each group according to the random number table.Patients in group L received intravenous pumping of lidocaine with a load of 1.5 mg·kg^(-1)during induction for 10 min,and then a continuous rate of 1.5 mg·kg^(-1)·h^(-1)until the end of the operation.Patients in group C received the same volume of saline in the same way.After the laryngeal mask was intubated,bispectral index(BIS)was maintained at 40-50 during the operation.The visual analogue scale(VAS)scores at the time of 15 min after removal of the laryngeal mask,2,6,12,24,48 and 72 h after the operation were assessed and recorded.The dosages of propofol and remifentanil,the times of postoperative remedial analgesia(fentanyl 50μg)when the scores of VAS≥4 were recorded.The time of wake-up,PACU stay,first intestinal exhaust,postoperative ambulation out of bed,and hospital stay after operation,the occurrences of nausea and vomiting(PONV)and related adverse events were also recorded.RESULTS Compared with group C,the VAS scores of group L decreased significantly at the time of 15 min after removal of the laryngeal mask,2,6,12,24,and 48 h after operation(P<0.05),while at 72 h,there was no significant difference(P>0.05).The doses of propofol and remifentanil,and the times of remedial analgesia in group L were less than those in group C(P<0.05).The time of wake-up,PACU stay,first intestinal exhaust,postoperative ambulation and hospital stay after operation in group L were earlier than those in group C(P<0.05).The incidence of PONV in group L was lower than that in group C(P<0.05).No related adverse drug reactions occurred in 2 groups.CONCLUSION Intravenous pumping of lidocaine can safely and effectively relieve the postoperative pain of patients undergoing FURL and it has a positive effect on the rapid recovery of patients after surgery.