经尿管持续输注利多卡因用于泌尿外科手术病人术后镇痛的效果  

Efficacy of continuous infusion of lidocaine through urinary catheter for postoperative analgesia in patients undergoing urological surgery

作　　者：郭晓璐 章放香[1] 张继勤 秦晨光[1] 赵倩[1] 吴俣樨 Guo Xiaolu;Zhang Fangxiang;Zhang Jiqin;Qin Chenguang;Zhao Qian;Wu Yuxi(Department of Anesthesiology,Guizhou Provincial People′s Hospital,Guiyang 550002,China)

机构地区：[1]贵州省人民医院麻醉科,贵阳550002

出　　处：《中华麻醉学杂志》2021年第5期580-583,共4页Chinese Journal of Anesthesiology

摘　　要：目的:评价经尿管持续输注利多卡因用于泌尿外科手术病人术后镇痛的效果。方法:择期全麻下行经皮肾镜碎石取石术男性病人40例,年龄65~75岁,BMI 18~25 kg/m^(2),ASA分级Ⅱ或Ⅲ级,采用随机数字表法分为2组(n=20):经尿管持续输注利多卡因组(L组)和病人自控静脉镇痛组(PCIA组)。2组病人均采用全凭静脉麻醉。术毕置入匹配型号的无菌尿道冲洗导尿管。L组经尿管以5 ml/h的速率持续输注0.5%利多卡因。PCIA组经尿管持续输注等容量0.9%生理盐水,并连接镇痛泵行PCIA,舒芬太尼125μg用生理盐水稀释至250 ml,背景输注速率为5 ml/h,PCA剂量5ml,锁定时间15 min。术后48 h内VAS评分>4分时,静脉注射舒芬太尼0.05μg/kg补救镇痛。分别于术毕即刻(T_(1))、术后6 h(T_(2))、术后24 h(T_(3))和术后48 h(T_(4))记录导管相关的膀胱不适(CRBD)发生情况及严重程度。于T_(1)和T_(2)时记录镇静和躁动Riker(SAS)评分;于T_(3)和4时记录QoR-9量表评分。于术前(T_(0))及T_(1~4)时点抽取外周静脉血标本,采用ELISA法检测血清皮质醇(Cor)、去甲肾上腺素(NE)、肾上腺素(E)和血糖(Glu)浓度。记录患首次下床时间、首次肛门排气时间、术后住院时间和术后48 h补救镇痛情况及恶心呕吐、呼吸抑制、低血压、皮肤瘙痒等发生情况。结果:与PCIA组比较,L组T_(1~4)时CRBD发生率降低,程度减轻,T_(1,2)时SAS评分降低,T_(3,4)时QoR-9评分升高,T_(1~4)时血清Cor、NE、E和Glu浓度降低,术后补救镇痛率降低,首次下床时间、首次肛门排气时间和术后住院时间缩短,术后恶心呕吐、呼吸抑制、低血压和皮肤瘙痒的发生率降低(P<0.05)。结论:经尿管持续输注利多卡因可为泌尿外科手术病人提供良好的术后镇痛效果,可降低术后应激反应和不良反应,有利于术后早期恢复。Objective To evaluate the efficacy of continuous infusion of lidocaine via urinary catheter for postoperative analgesia in patients undergoing urological surgery.Methods Forty male American Society of Anesthesiologists physical statusⅡorⅢpatients,aged 65-75 yr,with body mass index of 18-25 kg/m^(2),scheduled for elective percutaneous nephrolithotomy,were divided into 2 groups(n=20 each)using a random number table method:continuous infusion of lidocaine through urinary catheter group(group L)and patient controlled intravenous analgesia(PCIA)group(group PCIA).All the patients underwent total intravenous anesthesia,and a matched type of sterile urethral irrigation catheter was inserted after the operation.In group L,0.5%lidocaine was continuously infused at a rate of 5 ml/h via the urinary catheter,while the equal volume of 0.9%normal saline was continuously infused via the urinary catheter,and PCIA was connected in group PCIA.PCIA solution contained sufentanil 125μg(diluted to 250 ml in normal saline),and the PCA pump was set up with a 5 ml bolus dose,a 15 min lockout interval and background infusion at a rate of 5 ml/h.When visual analogue score was>4,sufentanil 0.05μg/kg was injected intravenously as rescue analgesic.The development and severity of catheter-related bladder discomfort(CRBD)were recorded immediately at the end of the operation(T_(1)),and at 6 h(T_(2)),24 h(T_(3))and 48 h(T_(4))after the operation,respectively.Riker sedation-agitation scale(SAS)score was recorded at T_(1,2),and QoR-9 scale was recorded at T_(3,4).The concentrations of serum cortisol(Cor),norepinephrine(NE),epinephrine(E)and blood glucose(Glu)were measured by enzyme linked immunosorbent assay.First off-bed time,exhaust time,length of hospital stay after surgery,and the requirement for rescue analgesia and adverse reactions(nausea and vomiting,respiratory depression,hypotension,skin itching)within 48 h after the operation were recorded.Results Compared with group PCIA,the incidence of CRBD and the severity were significantly dec

关 键 词：导尿管 利多卡因 疼痛 手术后 镇痛 泌尿外科手术 

分 类 号：R614[医药卫生—麻醉学]