静脉输注利多卡因对腹部手术患者术后镇痛效果及肠道功能恢复的影响

Effect of intravenous infusion of lidocaine to postoperative analgesic and the return of bowel function in patients underwent abdominal cavity surgery

目的研究静脉输注利多卡因对开腹手术患者术后镇痛效果及肠功能恢复的影响。方法选择60名·ASAI-Ⅲ级择期行腹部手术的患者，应用随机数字表法进行完全随机化分组分为3组，每组20人：u组、L2组、S组。采用双盲法，诱导时，L1组诱导时静注1．5mg／kg利多卡因后按2mg·kg-1·h-1的速度维持至术毕，术后以0．5mg·kg-1·h-1的速度持续输入48h，L2组诱导时静注1．5mg／kg利多卡因后按mg·kg-1·h-1的速度维持至术毕，术后以0．25mg·kg-1·h-1的速度持续输入48h，对照组给予等体积的生理盐水。术中采用丙泊酚、瑞芬太尼全凭静脉麻醉。术后采用吗啡行自控式静脉镇痛（patient controlled intravenous analgesia，PCA）。测量手术结束时、术后24、48h利多卡因的血药浓度。记录手术时间、术中瑞芬太尼用量、术后2、6、12、24、48h吗啡消耗量、PCA按压次数、静息及咳嗽时疼痛视觉模拟评分（visual analog score，VAS）、首次排气及排便时间。结果与S对照组相比，静脉输注利多卡因可减少患者术中瑞芬太尼的用量、术后48h的吗啡消耗量及PCA按压需求（P〈0．05），促进术后早期排气排便（P〈0．05）。手术结束时、术后24、48h利多卡因血药浓度分别为L1组（2．8±111）、（1．7±0．7）、（1．5±0．5）mg／L，L2组（2．6±1．2）、（1．1±0．4）、（0．9±0．3）mg／L。结论围术期静脉输注利多卡因可减少开腹手术患者术中阿片类药物用量，增强术后镇痛效果，促进患者术后肠道功能的恢复。

Objective To assess the effect of intravenous low-dose lidocaine infusion on postoperative analgesic and the return of bowel function in patients underwent abdominal cavity surgery. Methods Sixty ASA I-Ⅲ patients scheduled to undergo abdominal cavity surgery were randomly divided into groups L1,L2 and control group S. In group L1, 1.5 mg/kg lidocaine was injected during anesthesia induction, then 2 mg·kg-1·h-1 IV intraoperatively and 0.5 mg·kg-1·h-1 for 48 h postoperatively. In group L2, the same lidocaine application as group L1 except 0.25mg·kg-1·h-1 IV for 48 h postoperatively. In group control, an equal volume of saline were given. Anesthesia was maintained by propofol and remifentanil. Postoperative analgesia was provided by only patient-controlled analgesia with morphine. Blood samples were taken to measure plasma lidocaine concentrations at the end of surgery, 24 h and 48 h after operations. Postoperative pain was evaluated by visual analog score （VAS）. VAS was measured at rest and during coughing at 2,6,12,24,48 h postoperatively. Record the consumption of morphine, number of PCA press times, and the times of first flatus and defecation. Results Contrast with the control group, lidocaine reduced remifentanil consumption during surgery as well as postoperative morphine consumption, and shorten times to first flatus and defecation. Corresponding plasma lidocaine concentrations at the end of Surgery, 24 h and 48 h after operations were （2.8±1.i） mg/L,（1.7±0.7） mg/L,（1.5±0.5） mg/L in group L1 and （2.6±1.2） mg/L,（1.1±0.4） mg/L,（0.9±0.3） mg/L in group L2. Conclusion Intravenous lidocaine Improves postoperative analgesia and bowel function recovery after abdominal cavity surgery and reduces opium consumption during surgery.