利多卡因对妇科手术患者术后镇痛和恢复质量的影响

Influence of lidocaine on the postoperative analgesia and recovery qualityof patients underwentgynecological surgery

目的探讨术中静脉注射利多卡因对妇科腹腔镜手术患者术后镇痛和恢复质量的影响。方法选择2020年3—12月本院收治的60例ASAⅠ-Ⅱ级的拟行妇科腹腔镜子宫切除手术患者作为研究对象,以随机数表法分为对照组和利多卡因组两组,每组各30例。利多卡因组诱导前静脉推注利多卡因1.5 mg/kg,术中泵注2 mg/kg/h维持,对照组应用等量的生理盐水。比较两组患者术中动脉压、心率和术后麻醉恢复情况、术后恶心呕吐(PONV)、排气时间、排便时间、出院时间、恢复情况QOR-40评分、术后疼痛VAS评分和镇静RSS评分。结果利多卡因组患者的苏醒时间和拔管时间均长于对照组,差异具有统计学意义(P<0.05);而瑞芬太尼用量和术后24 h补救镇痛量均明显小于对照组,差异具有统计学意义(P<0.05);利多卡因组患者的PONV发生率显著低于对照组,差异具有统计学意义(P<0.05);利多卡因组患者的首次排气时间和排便时间显著短于对照组,差异具有统计学意义(P<0.05);但两组患者出院时间比较,差异无统计学差异(P>0.05);术后第1、3天,利多卡因组患者的QoR-40评分明显高于对照组,差异具有统计学意义(P<0.05);术后第5天,两组患者的QoR-40评分比较,差异无统计学差异(P>0.05);术后18 h、24 h、30 h、36 h,利多卡因组患者的VAS评分均低于对照组,差异具有统计学意义(P<0.05);拔管后1 min、5 min、30 min,两组患者的RSS评分比较,差异无统计学差异(P>0.05)。结论妇科腹腔镜术中静脉应用利多卡因可改善患者术后肠道功能,改善镇痛效果,提高术后恢复质量。

Objective To investigate the influence of intravenous administration of lidocaine on the postoperative analgesia and recovery quality of patients after laparoscopic gynaecological surgery.Methods A total of sixty patients of ASAI-II those intend to undergoing gynecological laparoscopic hysterectomy in our hospital from March 2020 to December 2020 were enrolled as study subjects.According to random number table method they were assigned to two groups:Group L(lidocaine group)and Group C(control group),30 cases in each group.The patients in group L received intravenous administration of lidocaine at 1.5mg/kgbefore induction and maintained at 2mg/kg/h throughout the operation,while patients in group C were given a saline infusion.Intraoperative arterial pressure,heart rate,postoperative recovery,post operative nausea and vomiting(PONV),exhaust time,defecation time,discharge time,QOR-40 score for recovery,VAS score for postoperative pain,and RSS score of composure of the two groups were compared.Results The recovery time and extubation time of lidocaine group were longer than those of control group,the difference was statistically significant(P<0.05).The total dose of remifentanil in group Lwas significantly lower than the control group(P<0.05).The incidence of PONV in lidocaine group was significantly lower than that in control group,the difference was statistically significant(P<0.05).The first exhaust time and defecation time in lidocaine group were significantly shorter than those in control group,with statistical significance(P<0.05).However,there was no significant difference in discharge time between the two groups(P>0.05).The QOR-40 score in group L at 1 and 3 days after the operationwas significantly lower than that in group C(P<0.05).On the 5th day after surgery,there was no significant difference in QOR-40 scores between the two groups(P>0.05).At 18h,24h,30h and 36h after surgery,VAS scores in lidocaine group were lower than those in control group,the differences were statistically significant(P<0.05).There was no significant difference in the RSS scores between the two groups at 1min,5min and 30min after extubation(P>0.05).Conclusions Intravenous lidocaine administered to patients undergoing laparoscopic gynaecological surgery may improve the gastrointestinal function,analgesia effect and the recovery after surgery.