静注利多卡因对行腹腔镜胆总管探查术患者镇痛和肠蠕动的影响

The effect of lidocaine on postoperative pain and peristalsis in patients undergoing laparoscopic common bile duct exploration

目的观察静脉输注利多卡因对行腹腔镜胆管探查术患者术后镇痛和肠功能的影响。方法择期腹腔镜胆总管探查术患者80例,年龄23～55岁,ASAⅠ或Ⅱ级,随机均分为治疗组和对照组。治疗组诱导期静注利多卡因1.5mg/kg,术中以2mg·kg-1·h-1持续输注,术后24h内改为1.2mg·kg-1·h-1持续静脉输注。对照组给予等剂量的生理盐水。记录两组患者术中七氟醚总量,术后抽取静脉血检测利多卡因浓度并记录术后2h(T1)、4h(T2)、8h(T3)、12h(T4)、24h(T5)、术后第2天(T6)和第3天(T7)两组VAS评分以及术后首次排气、排便时间,住院天数和恶心呕吐发生率。结果与对照组比较,T1～T5时治疗组VAS评分均明显下降(P<0.05);治疗组术中七氟醚总量降低,术后首次排气时间、排便时间以及住院天数均缩短(P<0.05)。结论小剂量利多卡因静注可促进腹腔镜胆管探查术患者肠蠕动恢复,缩短患者住院时间,有利于术后康复。

Objective To investigate the effect of continuous infusion of lidocaine on postoperative pain and peristalsis in patients undergoing laparoscopic common bile duct exploration. Methods Eighty selective elderly patients scheduled for laparoscopic common bile duct exploration were randomly divided into control group （40 cases）and treamlem group（40 cases）. Treatment group received bolus lidocaione 1.5 mg/kg iv during anestbesia induction followed by 2 mg·kg^-1 ·h^-1 intraoperatively and 1.2 mg·kg^- 1 ·b^- 1 for 24 h postoperatively. Control group received equal volumes of saline The total armunt of anesthetics and plasma lidocaine concentrations were recorded after the surgery. VAS scores at 2 h （T1）, 4 h （T2）, 8 h （T3）, 12 h （T4）, 24 h （T5）after the surgery, and also the second （T6） and third postoperative day （TT） were compared. The time of flatus and defecation, the incidence of nausea and vomiting, and total hospital stay were also observed. Results Compared with control group, the VAS score at T1- T5 after surgery in the treatment group decreased significantly. The total amount of sevoflurane, time of flatus and defecation and total hospital stay decreased in treatment group. Conclusion Small dose of lidocaine is beneficial for peristalsis and hospital stay for patients undergoing laparoscopic common bile duct exploration, which is good for postoperative rehabilitation.