利多卡因复合右美托咪定对腹腔镜全子宫切除患者术后恢复质量的影响

Effect of lidocaine combined with dexmedetomidine on postoperative recovery quality of patients undergoing laparoscopic hysterectomy

目的观察麻醉诱导前静脉泵注利多卡因复合右美托咪定对腹腔镜全子宫切除患者术中阿片类药物用量和术后恢复质量的影响。方法选择择期行腹腔镜全子宫切除患者60例,年龄36~64岁,BMI 20.0~26.0 kg/m^(2),ASAⅠ或Ⅱ级。采用随机数字表法将患者分为两组:利多卡因+右美托咪定组(LD组)与对照组(C组),每组30例。LD组麻醉诱导前10 min静脉泵注2%利多卡因1.5 mg/kg和右美托咪定0.5μg/kg,随后分别泵注2%利多卡因1.5 mg·kg-1·h-1和右美托咪定0.4μg·kg-1·h-1,手术结束前30 min停止输注。C组麻醉诱导前10 min静脉泵注等容量的生理盐水。两组围麻醉期持续输注瑞芬太尼。记录术中瑞芬太尼和丙泊酚总用量、手术结束前30 min内瑞芬太尼用量。记录术后2、6、12、24 h的VAS疼痛评分和术后补救镇痛例数。记录术前1 d与术后1 d QoR-40量表总分。记录术后24 h恶心、呕吐、口干和嗜睡等不良反应的发生情况。结果与C组比较,LD组术中瑞芬太尼和丙泊酚总用量、手术结束前30 min内瑞芬太尼用量明显减少、术后补救镇痛率明显降低(P<0.05),术后6、12、24 h的VAS疼痛评分和术后恶心、呕吐发生率明显降低(P<0.05),术后1 d QoR-40量表总分和口干、嗜睡发生率明显升高(P<0.05)。结论麻醉诱导前静脉泵注利多卡因复合右美托咪定可减少术中阿片类药物用量,并在一定程度上改善腹腔镜全子宫切除患者术后恢复质量,降低术后VAS疼痛评分与恶心、呕吐发生率,但口干和嗜睡发生率升高。

Objective To observe the effect of intravenous pumping lidocaine combined with dexmedetomidine before anesthesia induction on intraoperative opioid dosage and quality of recovery after laparoscopic hysterectomy.Methods A total of sixty women undergoing elective laparoscopic hysterectomy,aged 36-64 years,BMI 20.0-26.0 kg/m^(2),ASA physical statusⅠorⅡ,were allocated into two groups according to a random number table:lidocaine combined with dexmedetomidine group(group LD)and control group(group C),30 patients in each group.Patients in group LD received bolus infusion of lidocaine 1.5 mg/kg and dexmedetomidine 0.5μg/kg over 10 minutes before induction of anesthesia,respectively,then lidocaine and dexmedetomidine was infused respectively at a rate of 1.5 mg·kg-1·h-1 and 0.4μg·kg-1·h-1,and which was ceased 30 minutes before the end of surgery.Patients in group C received the equal volume of saline 10 minutes before induction of anesthesia.Remifentanil was infused in the perioperative anesthesia period.The remifentanil and propofol dose,remifentanil dose 30 minutes before the end of the surgery,the VAS pain scores 2,6,12,and 24 hours after surgery,QOR-40 scale scores 1 day before and after surgery,and additional analgesia were recorded.The incidence of nausea,vomiting,dry mouth,and drowsiness within 24 hours after surgery were recorded.Results The dosage of remifentanil and propofol in the perioperative period and remifentanil dose 30 minutes before the end of the surgery in group LD were lower than those in group C(P<0.05).The analgesic rates of group LD were lower than those in group C(P<0.05).The VAS scores 6,12 and 24 hours after surgery in group LD were lower than those in group C(P<0.05).Compared with group C,the incidence of postoperative nausea and vomiting was significantly lower in group LD.The QoR-40 score in group LD was higher than that in group C 1 day after surgery(P<0.05).However,the incidence of dry mouth and drowsiness in group LD was higher than that in group C(P<0.05).Conclusion Intravenous pumping lidocaine combined with dexmedetomidine before anesthesia induction can reduce consumptions of opioids drugs,improve postoperative recovery quality to some extent,reduce postoperative pain score and the incidence of postoperative nausea and vomiting,but increase the incidence of dry mouth and drowsiness in patients undergoing laparoscopic hysterectomy.