右美托咪定复合利多卡因对腹腔镜手术患者术后自主神经功能及肠道运动功能的影响  

Effects of Dexmedetomidine Combined with Lidocaine on Postoperative Autonomic Nerve Function and Intestinal Motor Function in Patients Undergoing Laparoscopic Surgery

作　　者：张锋 刘鹤[2] ZHANG Feng;LIU He(Department of Anesthesiology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,Jiangsu,China;Department of Anesthesiology,Huzhou Central Hospital,Huzhou 313003,Zhejiang,China)

机构地区：[1]徐州医科大学附属医院麻醉科,江苏徐州221000 [2]湖州市中心医院麻醉科,浙江湖州313003

出　　处：《医学信息》2023年第1期117-121,共5页Journal of Medical Information

摘　　要：目的探讨右美托咪定复合利多卡因对腹腔镜手术患者术后自主神经功能及肠道运动功能的影响。方法选取2019年1月-2022年6月于本院行腹腔镜下全子宫切除术的患者78例,按照单双号法分为对照组与观察组,各39例。两组均采用全凭静脉麻醉,麻醉方案均采用丙泊酚+瑞芬太尼,观察组麻醉诱导前静脉泵注利多卡因与右美托咪定,对照组麻醉诱导前静脉泵注相同体积生理盐水,术后均根据患者疼痛耐受情况给予曲马多口服。比较两组术前及术后1、2 d心脏自主神经功能[心率变异性(HRV):总功率频段(TP)、低频段(LF)、高频段(HF)、低频段与高频段比值(LF/HF)]、应激指标[皮质醇(COR)、肾上腺素(E)]、炎性指标[白细胞介素-6(IL-6)、C反应蛋白(CRP)]水平;比较两组术中丙泊酚及瑞芬太尼用量、苏醒时疼痛程度[视觉模拟评分法(VAS)]、术后48 h曲马多用量、术后肠道运动功能(出现肠鸣音时间、肛门排气时间、排便时间与首次进食固态食物时间)恢复情况及不良反应发生率。结果观察组术后1 d LF低于术前,且低于对照组(P<0.05);对照组术后1 d HF、TP低于术前,且低于观察组(P<0.05);对照组术后1 d LF/HF高于术前,且高于观察组(P<0.05);两组术后1 d与术后2 d COR、E、IL-6、CRP水平均高于术前,但观察组术后1 d COR、E、IL-6、CRP水平低于对照组(P<0.05);观察组术中丙泊酚及瑞芬太尼用量、苏醒时VAS评分及术后48 h曲马多用量均低于对照组(P<0.05);观察组术后出现肠鸣音时间、肛门排气时间、排便时间与首次进食固态食物时间均短于对照组(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论右美托咪定复合利多卡因能有效改善腹腔镜手术患者术后自主神经功能紊乱,减轻应激与炎性反应,促进肠道功能恢复,镇痛效果好,安全性良好。Objective To investigate the effect of dexmedetomidine combined with lidocaine on postoperative autonomic nerve function and intestinal motor function in patients undergoing laparoscopic surgery.Methods Seventy-eight patients who underwent laparoscopic total hysterectomy in the hospital from January 2019 to June 2022 were selected and divided intocontrol group and observation group according to the odd-even number method,with 39 cases in each group.Both groups were treated with total intravenous anesthesia with propofol and remifentanil,and the observation group was intravenously pumped with lidocaine and dexmedetomidine before anesthesia induction,and the control group was intravenously pumped with the same volume of normal saline before anesthesia induction,and both groups were given oral tramadol according to the pain tolerance of patients after surgery.Cardiac autonomic nerve function[heart rate variability(HRV):total power frequency band(TP),low frequency band(LF),high frequency band(HF),low frequency-to-high frequency ratio(LF/HF)],stress indicators[cortisol(COR),epinephrine(E)]and inflammatory indicators[interleukin-6(IL-6),C-reactive protein(CRP)]before surgery and at 1 day and 2 days after surgery,intraoperative dosages of propofol and remifentanil,pain degree[Visual Analogue Scale(VAS)]during recoveryand dosage of tramadol at 48 hours after surgery,recovery of postoperative intestinal motor function(onset time of bowel sounds,anal exhaust time,defecation time and time of first eating solid food)and incidence rate of adverse reactions were compared between the two groups.Results LF in observation group at 1 day after surgery was lower than that before surgery and that in control group(P<0.05).The HF and TP in control group at 1 day after surgery were lower than those before surgery,and the two indicators in observation group were higher than those in control group(P<0.05).The levels of COR,E,IL-6 and CRP in the two groups at 1 day and 2 day after surgery were higher than those before operation,but the le

关 键 词：右美托咪定 利多卡因 腹腔镜 自主神经功能 肠道运动功能 

分 类 号：R614[医药卫生—麻醉学]