静脉输注利多卡因对老年患者腹腔镜下结肠癌根治术后疼痛和认知功能的影响  

Effects of intravenous infusion of lidocaine on postoperative pain and cognitive function in elderly patients undergoing laparoscopic radical colon cancer surgery

作　　者：李亚星 高晓宁 孙艳斌[2] 王丽 杜凌云[3] LI Yaxing;GAO Xiaoning;SUN Yanbin(Chengde Medical University,Chengde 067000,CHINA)

机构地区：[1]承德医学院,河北067000 [2]承德市中心医院麻醉科 [3]承德市中心医院手术室

出　　处：《江苏医药》2023年第3期264-267,共4页Jiangsu Medical Journal

摘　　要：目的观察静脉输注利多卡因对腹腔镜下结肠癌根治术老年患者术后疼痛和认知功能的影响。方法择期行腹腔镜下结肠癌根治术老年患者60例分为三组,每组20例。麻醉诱导前30 min,A、B组于10 min内静脉泵注利多卡因负荷量均为1.5 mg/kg,其后分别以1.0、3.0 mg·kg^(-1)·h^(-1)维持至术毕;C组给予等量生理盐水作为对照。记录麻醉诱导前(T0)、放置喉罩后即刻(T1)、放置喉罩后3 min(T2)和放置喉罩后6 min(T3)时的HR与MAP。记录三组患者术后2、6、24 h VAS疼痛评分和术后24 h内静脉患者自控镇痛(PCA)次数。于术前1 d、术后1 d和术后3 d,记录简易精神状态评价量表(MMSE)评分,计算术后认知功能障碍(POCD)发生率。结果三组T0~T3时HR与MAP比较差异无统计学意义(P>0.05)。A、B组术后2、6、24 h的VAS疼痛评分及术后24 h内PCA次数均少于C组(P<0.05),且B组PCA次数亦少于A组(P<0.05)。A、B组术后1、3 d的MMSE评分高于C组(P<0.05),且B组MMSE评分亦高于A组(P<0.05)。B组术后3 d的POCD发生率低于A、C组(P<0.05)。结论腹腔镜下结肠癌根治术中静脉应用利多卡因可减轻老年患者术后疼痛和术后POCD的发生,推荐利多卡因负荷量1.5 mg/kg静脉缓慢泵注,继以3.0 mg·kg^(-1)·h^(-1)持续泵注至术毕。Objective To observe the effects of intravenous infusion of lidocaine on postoperative pain and cognitive function in the elderly patients undergoing laparoscopic radical colon cancer surgery.Methods Sixty patients undergoing laparoscopic radical resection for colon cancer were randomly divided into three groups with 20 cases each.At 30 minutes before anesthesia induction,the lidocaine 1.5 mg/kg as a loading dose was intravenously infused within 10 minutes in groups of A and B,which was followed by pumping lidocaine 1.0(group A)or 3.0 mg·kg^(-1)·h^(-1)(group B)until the end of surgery.The same amount of normal saline was used in group C as the control.HR and MAP were recorded before anesthesia induction(T0),immediately(T1),3 minutes(T2)and 6 minutes(T3)after the laryngeal mask was placed.At the time points of 2^(nd),6^(th)and 24^(th)hour after surgery,the VAS pain score was evaluated,and the number of patient-controlled analgesia(PCA)within 24 hours after operation was recorded.The scores of MMSE and the incidence of POCD were recorded at the time points of one day before surgery,one day after surgery and 3 days after surgery.Results There were no significant differences in HR and MAP among three groups at T0 to T3(P<0.05).The VAS pain scores at the 2^(nd),6^(th)and 24^(th)hour after surgery and the PCA number within 24 hours after surgery in groups of A and B were less than those in group C(P<0.05).The PCA number in group B was less than that in group A(P<0.05).The MMSE score in groups of A and B was higher than that of group C(P<0.05),which of group B was higher than that of group A(P<0.05).The incidence of POCD in 3 days after operation in group B was lower than that in groups of A and C(P<0.05).Conclusion Intravenous infusion of lidocaine in the elderly patients undergoing laparoscopic radical operation for colon cancer can effectively alleviate postoperative pain and reduce POCD occurrence,for which it is recommended to slowly infuse a intravenous loading dose of lidocaine 1.5 mg/kg and then pump lidocaine

关 键 词：利多卡因 结肠癌 术后疼痛 认知功能 老年 

分 类 号：R614[医药卫生—麻醉学]