围手术期静脉输注利多卡因对上气道手术患者术后早期恢复质量的影响

Effect of perioperative intravenous lidocaine infusion on postoperative early recovery quality in patients undergoing upper airway surgery

目的研究围手术期静脉输注利多卡因对上气道手术患者术后早期恢复质量的影响。方法选择拟行上气道手术患者120例,采用随机数字表法将患者分为利多卡因组(L组)和对照组(C组),每组60例。L组给予利多卡因2.0 mg/kg,于麻醉诱导前10 min内注射完毕,后以2 mg·kg^-1·h%-1静脉输注至手术结束。C组以等体积生理盐水代替。记录患者术前(T0)、术后24 h(T1)、术后48 h(T2)40项恢复质量评分量表(40-item Quality of Recovery Score,QoR-40量表)评分,以及术中舒芬太尼用量、瑞芬太尼用量、48 h内术后恶心呕吐(postoperative nausea and vomiting,PONV)的发生率。结果与T0时比较,两组患者T1、T2时QoR-40量表总评分及身体舒适度、自理能力、心理支持、疼痛4个维度的评分明显降低,C组T1时情绪状态评分明显降低(P<0.05);L组T1、T2时QoR-40量表总评分及身体舒适度、情绪状态、疼痛3个维度的评分明显高于C组(P<0.05),其中T1时L组自理能力评分明显高于C组(P<0.05);L组术中瑞芬太尼用量明显少于C组(P<0.05);L组48 h内PONV的发生率明显低于C组(P<0.05)。结论围手术期静脉输注利多卡因可以提高上气道手术患者术后2 d的QoR-40评分,减少术中阿片类药物用量,降低PONV发生率,改善术后早期恢复质量。

Objective To investigate the effect of perioperative intravenous lidocaine infusion on postoperative early recovery quality in patients undergoing upper airway surgery.Methods One hundred and twenty patients undergoing upper airway surgery were divided into two groups according to a random number table:a lidocaine group(group L)and a control group(group C),with 60 patients in each group.Group L was administered with 2.0 mg/kg lidocaine over 10 min before induction of anesthesia,followed by intrave-nous infusion at 2 mg·kg^?1·h^?1 until the end of surgery.Group C was given the same volume of normal saline.The 40-item Quality of Recovery Score(QoR-40 score)as well as the consumption of sufentanil and remifentanil during surgery and the incidence of postoperative nausea and vomiting(PONV)were recorded before surgery(T0),24 h after surgery(T1)and 48 h after surgery(T2).Results The global QoR-40 scores and the scores for physical comfort,physical independence,psychological support and pain at T1 and T2 in two groups as well as the score for emotional state at T1 in group C were significantly lower than those at T0(P<0.05).Compared with those in group C,the global QoR-40 scores and the scores for physical comfort,emotional state,and pain significantly increased in group L at T1 and T2(P<0.05),where the score for physical independence in group L was superior to that in group C at T1(P<0.05).Compared with those in group C,the dosage of remifentanil used during surgery and the incidence of PONV within 48 h in group L significantly reduced(P<0.05).Conclusions Perioperative intravenous lidocaine infusion can improve QoR-40 scores in patients two days after upper airway surgery,reduce the dosage of opioids and the incidence of PONV and improve postoperative early recovery quality.