静脉泵注不同剂量利多卡因复合丙泊酚在妇科门诊手术中的应用效果  

Application of different doses of intravenous lidocaine combined with propofol in gynecological outpatient surgery

作　　者：马卫兰 宋凤香[1] 邓立琴[1] 王爱琪 张天静 邱玉雪[1] 侯海涛 MA Weilan;SONG Fengxiang;DENG Liqin;WANG Aiqi;ZHANG Tianjing;QIU Yuxue;HOU Haitao(Department of Anesthesiology,Hospital of Ningxia Medical University,Yinchuan 750004,Ningxia,China)

机构地区：[1]宁夏医科大学总医院麻醉科,750004 [2]宁夏医科大学附属吴忠市人民医院麻醉科

出　　处：《上海医学》2021年第1期31-35,共5页Shanghai Medical Journal

摘　　要：目的探讨静脉泵注不同剂量的利多卡因复合丙泊酚在妇科门诊手术中的应用效果。方法纳入2019年3—5月在宁夏医科大学总医院妇科门诊行宫腔镜手术和人工流产手术的患者200例,随机分为4组:丙泊酚组、低剂量利多卡因组、中剂量利多卡因组、高剂量利多卡因组,每组50例。4组均静脉注射丙泊酚至患者意识消失;除丙泊酚组外,其余3组均静脉注射利多卡因负荷量1.5 mg/kg,低剂量利多卡因组、中剂量利多卡因组和高剂量利多卡因组分别持续静脉泵注利多卡因2、4和6 mg/(kg·h)至手术结束。记录患者年龄、体重、ASA分级、麻醉诱导时间、手术时间、苏醒时间、离院时间、麻醉用药量;采用疼痛数字量表(numerical rating scale,NRS)评分法评估丙泊酚注射痛的程度;根据患者术中肢体活动情况评估术中麻醉效果;评估患者术后下腹疼痛程度;记录患者术中低氧血症的发生率、利多卡因和丙泊酚不良反应的发生情况。结果低剂量利多卡因组、中剂量利多卡因组、高剂量利多卡因组患者丙泊酚首次使用量、丙泊酚使用总量均显著低于丙泊酚组(P值均<0.05);中剂量利多卡因组、高剂量利多卡因组患者利多卡因使用量均显著高于低剂量利多卡因组(P值均<0.05)。丙泊酚组术后各时间点下腹疼痛的缓解率均显著低于低剂量利多卡因组、中剂量利多卡因组、高剂量利多卡因组同时间点(P值均<0.01),低剂量利多卡因组术后各时间点下腹疼痛的缓解率均显著低于中剂量利多卡因组、高剂量利多卡因组同时间点(P值均<0.05)。丙泊酚组轻度、中度、重度丙泊酚注射疼痛的发生率均显著高于低剂量利多卡因组、中剂量利多卡因组、高剂量利多卡因组,无痛率均显著低于低剂量利多卡因组、中剂量利多卡因组、高剂量利多卡因组(P值均<0.05)。中剂量利多卡因组、高剂量利多卡因组麻醉效果佳�Objective To the investigate the clinical application of intravenous infusion of different doses of lidocaine combined with propofol for gynecological outpatient surgery.Methods Two hundred outpatients undergoing hysteroscopy and abortion between March and May 2019 in our hospital were randomly divided into four groups(n=50):propofol group,low-dose lidocaine group,medium-dose lidocaine group and high-dose lidocaine group.Propofol was intravenously injected in patients in each group until the patient’s consciousness disappeared,and loadingdose of lidocaine(1.5 mg/kg)was given in three lidocaine groups.Then lidocaine(2 mg/[kg·h]in low-dose lidocaine group,4 mg/[kg·h]in medium-dose lidocaine group,and 6 mg/[kg·h]in high-dose lidocaine group)was continuously infused during operation.The patient’s age,weight,ASA grade,anesthesia induction time,operation time,recovery time,hospital leaving time and anesthetic dosage were recorded.The degree of propofol injection pain was assessed by numerical rating scale(NRS).The anesthesia effect was evaluated according to the limb activity during the operation.Postoperative lower abdominal pain,the incidence of hypoxemia and adverse reactions of lidocaine and propofol were recorded.Results The initial dose and total dose of propofol used in three lidocaine groups were significantly lower than those in propofol group(all P<0.05).The lidocaine consumption of medium-and high-dose lidocaine groups was significantly higher than that of low-dose lidocaine group(both P<0.05).At different postoperative time points,the incidence of lower abdominal pain in propofol group was significantly higher than those in other three groups(all P<0.01);and the incidence of lower abdominal pain in low-dose lidocaine group was significantly higher than those in medium-and high-dose lidocaine groups(all P<0.05).Compared with three lidocaine groups,the incidence of mild,moderate and severe propofol injection pain in propofol group was significantly increased,while the painless rate was significantly de

关 键 词：妇科 门诊外科手术 丙泊酚 利多卡因 下腹疼痛 

分 类 号：R614[医药卫生—麻醉学]