静注利多卡因对腹腔镜胆总管探查术患者镇痛和胃肠功能的影响分析

Analysis on the Impact of Intravenous Lidocaine on Analgesic and Gastrointestinal Function in Patients Undergoing Laparoscopic Common Bile Duct Exploration

目的:评价静注利多卡因对腹腔镜胆总管探查术患者镇痛和胃肠功能的影响。方法:选取2012年3月-2013年4月在本院肝胆外科择期行腹腔镜胆总管探查术的146例患者,按照入院号的奇偶性将其分为利多卡因组和生理盐水组各73例,利多卡因组采用利多卡因静注,生理盐水组采用等量生理盐水。记录两组患者手术时间、七氟醚用量、术后首次排气和排便时间、住院时间和不良反应发生情况,术后不同时点,采用VAS法对患者疼痛情况进行评分,利用高效液相色谱仪对血液标本中利多卡因进行监测。结果:利多卡因组患者术中七氟醚用量明显少于生理盐水组,首次排气时间、排便时间和住院时间均明显短于生理盐水组,差异均有统计学意义(P<0.05);利多卡因组患者术后2、6、12、24 h时VAS评分均明显低于生理盐水组,差异均有统计学意义(P<0.05);而48 h和72 h时VAS评分比较差异无统计学意义(P>0.05)。利多卡因组总不良反应发生率4.1%明显低于生理盐水组的19.2%,差异有统计学意义(P<0.05)。结论:合适剂量的利多卡因静注有助于改善腹腔镜胆管探查术患者术后镇痛效果,减少全麻药物用量,促进胃肠功能恢复,减少并发症的发生,利于术后康复。

Objective：To investigate the impact of intravenous lidocaine on analgesic and gastrointestinal function in patients undergoing laparoscopic common bile duct exploration.Method：146 patients underwent elective laparoscopic common bile duct exploration in the department of hepatobiliary surgery in our hospital were selected from March 2012 to April 2013.All cases were randomly divided into the lidocaine group and the saline group,73 cases in each group.The lidocaine group was given intravenous lidocaine and the saline group was given equivalent normal saline.The operative time,sevoflurane consumption,the first exhaust time and defecation time,hospital stay and adverse events of the two groups were recorded.At the different time points after surgery,the pain scores were evaluated by VAS law.The content of lidocaine of blood samples were monitored by high performance liquid chromatography.Result：The sevoflurane consumption of the lidocaine group was significantly less than the saline group,and the first exhaust time,defecation time and hospital stay were significantly shorter than the saline group,the differences were statistically significant（P〈0.05）.At 2,6,12,24 h after surgery,VAS scores of patients in lidocaine group were all significantly lower than the saline group,the differences were all statistically significant （P〈0.05）,but there were no significant difference at 48 h and 72 h VAS score（P〉0.05）.The total adverse reactions occurring rate in the lidocaine group was 4.1%,it was significantly lower than than 19.2%of the saline group,the difference was statistically significant（P〈0.05）.Conclusion：Suitable doses of intravenous can improve the effect of postoperative analgesia of patients undergoing laparoscopic bile duct exploration,reduce the amount of anesthesia drugs,promote recovery of gastrointestinal function,reduce the incidence of complications and promote postoperative rehabilitation.