术中持续静脉注射利多卡因对胸腔镜肺叶切除术患者术中麻醉用药及术后疼痛的影响  

Effect of continuous intraoperative intravenous injection of lidocaine on intraoperative anesthetic dose and postoperative pain in patients undergoing thoracoscopic lobectomy

作　　者：范筝 王海彬 刘中凯[2] Fan Zheng;Wang Haibin;Liu Zhongkai(School of Graduate,Shandong First Medical University&Shandong Academy of Medical Sciences,Taian 271000,China;Department of Anesthesiology,Linyi People's Hospital,Linyi 276000,China)

机构地区：[1]山东第一医科大学(山东省医学科学院)研究生部,泰安271000 [2]临沂市人民医院麻醉科,临沂276000

出　　处：《国际麻醉学与复苏杂志》2022年第3期258-263,共6页International Journal of Anesthesiology and Resuscitation

摘　　要：目的探讨利多卡因对胸腔镜肺叶切除术患者术中药物用量、术后恢复质量和术后慢性疼痛(postoperative chronic pain,CPSP)的影响。方法纳入择期胸腔镜下肺叶切除术患者90例,采用随机数字表法将患者分为利多卡因组(L组)和对照组(C组),每组45例。L组麻醉诱导时给予利多卡因1.0 mg/kg,后予利多卡因1.5 mg·kg^(−1)· h^(−1)持续泵入,至手术结束拔管前停药;C组给予等容量的生理盐水。比较两组患者一般情况;记录两组患者手术时间、麻醉时间、单肺通气时间、丙泊酚及瑞芬太尼用量,术后进入PACU、入PACU 30 min、术后12 h、术后24 h及术后48 h VAS疼痛评分,术后恶心、呕吐、首次排气时间、首次下床活动时间、总住院时间、术后住院时间及术后肺部并发症情况;术后24 h采用40项恢复质量评分量表(40⁃item Quality of Recovery Score,QoR⁃40量表)评估两组患者恢复情况,术后3个月评估两组患者CPSP发生率及利兹神经病理性症状和体征疼痛评分(Leeds Assessment of Neuropathic Symptoms and Sign,LANSS评分)>12分发生率。结果L组术中丙泊酚用量和瑞芬太尼用量均少于C组(P<0.05)。L组术后首次排气时间,恶心、呕吐发生率,入PACU 30 min、术后12 h、术后24 h VAS疼痛评分,术后3个月CPSP发生率、LANSS评分>12分发生率均低于C组(P<0.05),总住院时间长于C组(P<0.05);术后24 h QoR⁃40量表的舒适度评分、疼痛评分及总评分高于C组(P<0.05)。其他指标差异无统计学意义(P>0.05)。结论术中持续静脉输注利多卡因(诱导负荷量1.0 mg/kg,持续1.5 mg·kg^(−1)·h^(−1))减少胸腔镜下肺叶切除术患者术中麻醉药用量,减轻术后疼痛和恶心呕吐,改善患者术后恢复质量,同时降低CPSP和神经病理性疼痛的发生率。Objective To investigate the effect of lidocaine on the dosage of medications,postoperative recovery quality and postoperative chronic pain(CPSP)in patients undergoing thoracoscopic lobectomy.Methods Ninety patients who were scheduled for thoracoscopic lobectomy were included.According to the random number table method,they were divided into two groups(n=45):a lidocaine group(group L)and a control group(group C).Group L was given 1.0 mg/kg lidocaine during anesthesia induction,followed by continuous pumping of lidocaine at 1.5 mg·kg^(−1)· h^(−1) until extubation.Group C was given the equal volume of normal saline.Both groups were compared for their general information;operation time,anesthesia time,one⁃lung ventilation time,propofol and remifent⁃anil dosage;the Visual Analogue Scale(VAS)scores at the time of admission to post⁃anesthesia care unit(PACU),30 min after admis⁃sion to PACU,and 12,24 h and 48 h after surgery;postoperative nausea,vomiting,time to first anal exhaust,time to first out-of-bed ac⁃tivity,total length of hospitalization stay,postoperative length of hospitalization stay,and postoperative pulmonary complications.The 40 item Quality of Recovery Score(QoR⁃40)was scored 24 h after surgery.The incidence of CPSP and the Leeds Assessment of Neuro⁃pathic Symptoms and Sign(LANSS score)>12 points in both groups were recorded 3 months after surgery.Results The intraopera⁃tive propofol dosage and remifentanil dosage in group L were less than those in group C(P<0.05).In group L,the time to first anal ex⁃haust,the incidence of nausea and vomiting,VAS scores 30 min after admission to PACU,12 h and 24 h after surgery,the incidence of CPSP and LANSS scores>12 points 3 months after surgery were lower than those in group C(P<0.05),and the length of hospitalization stay was longer than that in group C(P<0.05).The comfort,pain score and total score of the QoR⁃40 scores 24 h after surgery in group L were higher than those in group C(P<0.05).There were no significant differences in other ind

关 键 词：利多卡因 胸腔镜肺叶切除术 术后慢性疼痛 术后恢复 40项恢复质量评分量表 

分 类 号：R614[医药卫生—麻醉学]