经腹腔给予利多卡因对腹腔镜全子宫切除术患者术后镇痛及住院时间的影响

Intraperitoneal administration of Lidocaine on postoperative analgesia and hospital stay in patients undergoing laparoscopic hysterectomy

摘要:

目的??探讨经腹腔内给予利多卡因对腹腔镜全子宫切除术患者术后镇痛效果及术后住院时间的影响。方法?选择妇科择期在全身麻醉下行腹腔镜全子宫切除术并要求术后镇痛的患者96例，美国麻醉医师协会分级（ASA）Ⅰ或Ⅱ级，采用随机数字表法将所有患者随机分为对照组（C组），利多卡因组（L组），每组48例。两组患者接受相同的麻醉方法，在撤除腹腔镜前，L组患者经腹腔内给予2%利多卡因2.00 mg/kg，C组患者经腹腔内给予7.0 ml生理盐水。术毕各组患者注射负荷剂量舒芬太尼后开启静脉自控镇痛泵（舒芬太尼2.0μg/kg+生理盐水至100.0 ml）。由另一位麻醉医生观察并记录每位患者镇痛开始即刻（T0）、2 h（T1）、4 h（T2）、8 h（T3）、12 h（T4）、24 h（T5）及撤泵后2 h（T6）的视觉模拟评分（VAS）、平均动脉压（MAP）、脉博血氧饱和度（SpO2）、呼吸频率（RR）、心率（HR）、总按压次数、总用药量和不良事件例数及患者术后的住院时间。结果?与C组相比，L组患者在T5～6时间点的MAP、RR和HR明显较低，差异有统计学意义（P <0.05）；L组患者自控镇痛泵的总按压次数及总用药量明显低于C组，差异有统计学意义（P <0.05）；L组患者镇痛期间恶心呕吐发生率明显低于C组，L组患者的术后住院天数明显少，差异有统计学意义（P <0.05）。结论?经腹腔内给予利多卡因利于加强腹腔镜全子宫切除术患者术后镇痛效果，节约镇痛药物的用量，减轻不良反应发生，并缩短了术后住院时间，利于患者康复。

Abstract:

Objective?To explore the effect of intraperitoneal administration of Lidocaine on postoperative analgesia and hospital stay in patients undergoing laparoscopic hysterectomy.?Methods?96 patients, scheduled for laparoscopic hysterectomy, ASAⅠ~Ⅱ, were randomly divided into control group (C group) and Lidocaine group (L group), 48 cases in each. The same anesthesia method was given to all the patients. After removal of laparoscopy before intraperitoneal administration of Lidocaine 2.00 mg/kg in L group, C group were treated by intraperitoneal administration of saline 7 ml. Patients in each group were injected with the loading dose of Fentanyl to open the intravenous self controlled analgesia pump. Each patient’s MAP, SpO2, RR, HR, the number of cases of adverse events and the length of hospital stay after operation were observed and recorded by another anesthesiologist at the beginning of PCIA (T0), 2 h (T1), 4 h (T2), 8 h (T3), 12 h (T4), 24 h (T5) after the beginning of PCIA and 2 h after the removal of analgesia pump (T6).?Results?Compared with C group, patients’ MAP, RR, HR in L group were significantly lower at T5-6 (P < 0.05). In L group, the total pressure and the total amount of the patient controlled analgesia pump were significantly lower than that in C group (P < 0.05). Compared with C group, the incidence of nausea and vomiting in L group was significantly lower than that in C group, the number of postoperative hospital stay was significantly lower, the difference was statistically significant (P < 0.05).?Conclusion?The intraperitoneal administration of Lidocaine to enhance the effect of postoperative analgesia in patients undergoing laparoscopic hysterectomy can save the dosage of analgesic drugs, reduce adverse reactions, and shorten the postoperative hospital stay, which is conducive to the rehabilitation of patients.