静脉应用利多卡因对腹腔镜胆囊切除术后 女性患者肠麻痹的影响

Effect of intravenous lidocaine on intestinal paralysis after laparoscopic cholecystectomy

摘要:

目的 观察静脉应用利多卡因对全身麻醉下行腹腔镜胆囊切除术患者术后肠麻痹的影响。 方法 选取2016 年12 月—2017 年5 月在锦州医科大学附属第一医院行腹腔镜下胆囊切除术的60 例女性患 者，随机分为观察组和对照组，每组30 例。美国麻醉师协会分级Ⅰ、Ⅱ级，年龄38 ～ 55 岁，体重≤ 70 kg。 观察组麻醉诱导后静脉注射利多卡因1.5 mg/kg，随后持续静脉泵注1.5 mg/（kg·h）直至术毕；对照组给予 等剂量生理盐水，术毕2 h 后开始监测患者首次肠鸣音恢复时间及肛门排气时间，记录术毕拔管即刻和术后4、 8、12、24 及48 h 各时间点视觉模拟评分（VAS），记录术中及术后48 h 内阿片药物的用量与各组不良反应情况。 结果 两组各时间点VAS 评分差异有统计学意义（P <0.05）。观察组静息状态下VAS 评分较低。观察组术中 及术后48 h 内阿片药物用药量少于对照组（P <0.05）。观察组术后首次肠鸣音恢复时间、肛门排气时间短于对 照组，且不良反应发生率也低于对照组（P <0.05）。结论 全身麻醉下行腹腔镜胆囊切除术的女性患者麻醉 诱导及维持期持续静脉泵注利多卡因，可缩短术后肠麻痹时间，减少阿片类药物用量和术后相关不良反应。

Abstract:

Objective To observe the effect of intravenous lidocaine on the postoperative intestinal paralysis of female patients with general anesthesia after laparoscopic cholecystectomy. Methods Sixty female patients scheduled for laparoscopic cholecystectomy, ASAI-Ⅱ degree, age 38 to 55, weight no more than 70 kilogram, were randomly divided into observing group (n = 30) and control group (n = 30). In observing group, the intravenous injection of lidocaine was 1.5 mg/kg after anesthesia induction, and with a continuous infusion at a rate of 1.5 mg/ (kg·h) until the end of surgery; equal volume of saline was given in control group. After two hours of surgery, began to monitor the time for the first bowelsound and the fart resuming of patients. Pain scores were recored at 4 h, 8 h, 12 h, 24 h and 48 h after operation. Sufentanil consumption and the adverse reactions in each group were also recorded within 48h after operation. Results There was statistical difference in the pain scores between the two groups at any timepoint (P < 0.05). The sufentanil sufentanil was lower in observing group than that in control group (P < 0.05). The time for the first bowelsound and fart resuming and the rate of adverse reaction in observing group were significantly lower than that in control group (P < 0.05). Conclusion Continuous intravenous infusion of lidocaine was effective in shortening the duration of postoperative enteroparalysis with less sufentanil consumption and adverse effects after laparoscopic cholecystectomy.