静脉输注不同剂量利多卡因用于肛肠术后镇痛的临床研究

Clinical study on the postoperative analgesia effects of intravenous infusion of different dosages in patients undergoing anorectal surgery

目的观察静脉输注不同剂量利多卡因对肛肠术后镇痛效果及术后并发症的影响。方法选取2018年1月至2019年1月接受治疗的复杂肛瘘患者120例,随机分为对照组(C组)、利多卡因1组(L1组)、利多卡因2组(L2组)、利多卡因3组(L3组),每组30例。C组采用鞍麻。L1~L3组分别于麻醉诱导前静脉输注利多卡因1.0 mg/kg、1.5 mg/kg、2.0 mg/kg,稀释到10 ml 0.9%氯化钠溶液中,随后以1.0 mg·kg^-1·h^-1、1.5 mg·kg^-1·h^-1、2.0 mg·kg^-1·h^-1的速度持续输注至手术结束。术后4组均使用舒芬太尼自控静脉镇痛。比较4组术后2 h、4 h、8 h、12 h、24 h VAS评分、Ramsay镇静评分、BCS舒适度评分。记录4组术后24 h舒芬太尼用量、自控镇痛次数、双下肢肌力恢复时间、首次排气时间、首次排便时间、住院时间及并发症发生率。结果L组术后不同时间点VAS评分明显低于C组,Ramsay镇静评分、BCS舒适度评分明显高于C组,差异均有统计学意义(P<0.05)。L组术后24 h舒芬太尼用量、自控镇痛次数明显少于C组,双下肢肌力恢复时间、首次排气时间、首次排便时间、住院时间明显短于C组,并发症发生率明显低于C组,差异均有统计学意义(P<0.05)。结论静脉输注利多卡因1.5 mg/kg用于肛肠术后镇痛效果良好,并能够减少阿片类镇痛药用量,促进术后康复,且并发症发生率低。

Objective To investigate the effects of intravenous infusion of different dosages on postoperative analgesia effects and postoperative complicatins in patients undergoing anorectal surgery.Methods A total of 120 patients who underwent anorectal surgery in our hospital from January 2018 to January 2019 were enrolled in the study,who were randomly divided into four groups,with 30 cases in each group.The patients in control group(group C)were treated by saddle anesthesia.Before the induction of anesthesia,the patients in lidocaine groups(group L1,group L2 and group L3)were given intravenous injection of lidocaine with 1.0mg/kg,1.5mg/kg and 2.0mg/kg diluted to 10ml saline,were subsequently injected at the speed of 1.0mg·kg^-1·h^-1,1.5mg·kg^-1·h^-1,2.0mg·kg^-1·h^-1,respectively,till the enf of surgery,moreover the patients received patient-controlled intravenous analgesia of sufentanil after surgery.The VAS scores,Ramsay scores and Bruggrmann comfort scale(BCS)at 2h,4h,8h,12h and 24h were recorded.The usage amount of sufentanil within 24h after operation,the frequency of patient-controlled analgesia,muscle strength recovery time of both lower limbs,the times of postoperative firstly flatus and defecation,hospital stay and the incidence rate of complications were observed and compared.Results The VAS scores in group L1,group,L2 and group L3 were significantly lower than those in group C,however,the Ramsay scores and BCS scores at different time points in the three groups were significantly higher than those in group C(P<0.05).The usage amount of sufentanil within 24h after operation and the frequency of patient-controlled analgesia in the three groups were significantly less than those in group C(P<0.05),moreover,the muscle strength recovery time of both lower limbs,the times of postoperative firstly flatus and defecation,hospital stay and the incidence rate of complications in the three groups were significantly shorter than those in group C(P<0.05).Conclusion The intravenous infusion of 1.5mg·kg-1·h-1 lidocaine can improve the postoperative analgesia effects,reduce the dosage of opioid analgesics,promote the recovery of postoperative intestinal function of patients,with fewer incidence rates of complications,therefor,it is worthy of further promotion in clinical practice.