静脉输注利多卡因对腹腔镜下直肠癌根治术后患者镇痛效果的影响
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摘要
目的:观察静脉输注利多卡因对腹腔镜直肠癌根治术患者术后镇痛效果的影响。方法:选择择期全身麻醉下行腹腔镜下直肠癌根治术患者80例,年龄48～72岁,体重52～76 kg,ASAⅠ或Ⅱ级,采用随机数字表法将患者随机分为利多卡因组(L组)和对照组(C组),每组40例。L组于麻醉诱导前静脉注射利多卡因1 mg/kg稀释到10 ml生理盐水中,5 min推完,随后以1 mg/(kg·h)的速度持续输注至手术结束;C组以相同容量的生理盐水代替利多卡因。术毕两组患者均使用舒芬太尼100μg加格拉司琼6 mg稀释到100 ml生理盐水,自控静脉镇痛,维持VAS评分≤3分。分别于术后2 h、8 h、12 h、24 h、36 h和48 h行Ramsay镇静评分,记录患者术后48 h舒芬太尼用量、额外追加舒芬太尼用量、自控镇痛次数、术后首次排气、排便时间、恶心、呕吐发生情况以及住院时间。结果:与C组比较,L组患者术后2 h、8 h、12 h、24 h、36 h和48 h的Ramsay镇静评分明显升高,差异有统计学意义(P<0.05),术后48 h舒芬太尼用量、额外追加舒芬太尼用量、自控镇痛次数明显减少,差异有统计学意义(P<0.05),术后首次排气、排便时间明显缩短,差异有统计学意义(P<0.05),术后恶心明显减少以及住院时间明显缩短,差异均有统计学意义(P<0.05)。结论:对腹腔镜下直肠癌根治术的患者围术期静脉输注利多卡因,进行超前镇痛后,可有效提高镇痛效果,有效缓解术后疼痛,减少术后阿片类镇痛药物的用量,促进患者术后肠道功能的恢复,缩短患者住院时间。
Objective To observe postoperative analgesia effect of intravenous infusion of lidocaine to patients with laparoscopic resection of rectal cancer.Method Eighty patients,aged 48～72 years,weighing 52～76 kg and ASA class Ⅰ or Ⅱ,underwent laparoscopic radical resection of rectal cancer under general anesthesia in our hospital,and the patients were divided into lidocaine group(L group) and the control(C group) group,40 cases in each group.Before the induction of anesthesia,L group was carried out intravenous injection of lidocaine with 1 mg/kg diluted to 10 ml saline for 5 min,was subsequently injected with the speed of 1 mg/(kg·h) till the surgery was over.C group was carried out with physiological saline replacing lidocaine.At the end of the operation,two groups of patients were treated with sufentanil 100 μg and grasetron 6 mg diluted to 100 ml saline.The patient was controlled intravenous analgesia,and maintained a VAS score of 3 or less points.After operation,Ramsay sedation score was performed in 2 h,8 h,12 h,24 h,36 h,and 48 h,respectively.48 h sufentanil dosage,additional sufentanil dosage,frequency of self-control analgesia,first exhaust after operation,defecating time,occurrence of nausea and vomiting and the patient′s time of hospitalization were recorded after the operation.Results Compared with C group,L group showed higher Ramsay sedation score in 2 h,8 h,12 h,24 h,36 h,and 48 h(P<0.05).48 h sufentanil dosage,additional sufentanil dosage and frequency of self-control analgesia were obviously decreased(P<0.05).First exhaust after operation and defecating time were clearly shorten(P<0.05).Occurrence of nausea and vomiting and the patient′s time of hospitalization were clearly shorten(P<0.05).Conclusion After super town pain,intravenous infusion of lidocaine to patients with laparoscopic resection of rectal cancer effectively increased postoperative analgesia effect,reduced the dosage of opioid analgesics after operation,promoted the recovery of postoperative intestinal function in patients,shorten the patient′s time of hospitalization.
Objective To observe postoperative analgesia effect of intravenous infusion of lidocaine to patients with laparoscopic resection of rectal cancer.Method Eighty patients,aged 48～72 years,weighing 52～76 kg and ASA class Ⅰ or Ⅱ,underwent laparoscopic radical resection of rectal cancer under general anesthesia in our hospital,and the patients were divided into lidocaine group(L group) and the control(C group) group,40 cases in each group.Before the induction of anesthesia,L group was carried out intravenous injection of lidocaine with 1 mg/kg diluted to 10 ml saline for 5 min,was subsequently injected with the speed of 1 mg/(kg·h) till the surgery was over.C group was carried out with physiological saline replacing lidocaine.At the end of the operation,two groups of patients were treated with sufentanil 100 μg and grasetron 6 mg diluted to 100 ml saline.The patient was controlled intravenous analgesia,and maintained a VAS score of 3 or less points.After operation,Ramsay sedation score was performed in 2 h,8 h,12 h,24 h,36 h,and 48 h,respectively.48 h sufentanil dosage,additional sufentanil dosage,frequency of self-control analgesia,first exhaust after operation,defecating time,occurrence of nausea and vomiting and the patient′s time of hospitalization were recorded after the operation.Results Compared with C group,L group showed higher Ramsay sedation score in 2 h,8 h,12 h,24 h,36 h,and 48 h(P<0.05).48 h sufentanil dosage,additional sufentanil dosage and frequency of self-control analgesia were obviously decreased(P<0.05).First exhaust after operation and defecating time were clearly shorten(P<0.05).Occurrence of nausea and vomiting and the patient′s time of hospitalization were clearly shorten(P<0.05).Conclusion After super town pain,intravenous infusion of lidocaine to patients with laparoscopic resection of rectal cancer effectively increased postoperative analgesia effect,reduced the dosage of opioid analgesics after operation,promoted the recovery of postoperative intestinal function in patients,shorten the patient′s time of hospitalization.
引文
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[8] Chou R,Gordon DB,de Leon-Casasola OA,el al.Management of Postoperative Pain:A Clinical Practice Guideline From the American Pain Society,the American Society of Anesthesiologists Committee on Regional Anesthesia,Executive Committee,and Administrative Council[J].J Pain,2016,17(2):131.
[2] 马亮.利多卡因与舒芬太尼对丙泊酚注射痛预防作用的比较[J].吉林医学,2014,35(36):8013.
[3] Sultan A,McQuay HJ,Moore RA,et al.Single dose oral flurbiprofen for acute postoperative pain in adults.Cochrane Database Syst Rev,2009,8(3):CD007358.
[4] Kehlet H,Hole K.Effect of postoperative analgesia on surgical outcome[J].Br J Anaesth,2001,87(1):61.
[5] Taylor RJ,Pergolizzi JV,Raffa RB,et al.Opioids:pharmacology,clinical uses and adverse effects[J].Hauppauge,NY:Nova Science Publishers,Inc,2012,75:1.
[6] Zuliani V Rapalli A,Patel MK,et al.Sodium channel blockers:apatentreview(2010-2014).ExpertOpin Ther Pat,2015,25(3):279.
[7] 杨威.利多卡因喉部表面浸润麻醉对支撑喉镜全身麻醉手术患者心血管反应及术后躁动的影响[J].吉林医学,2017,38(11):2103.
[8] Chou R,Gordon DB,de Leon-Casasola OA,el al.Management of Postoperative Pain:A Clinical Practice Guideline From the American Pain Society,the American Society of Anesthesiologists Committee on Regional Anesthesia,Executive Committee,and Administrative Council[J].J Pain,2016,17(2):131.