术中利多卡因维持注射对胸腔镜下心脏瓣膜置换围术期麻醉药用量及CPSP发生的影响  

Effect of Intraoperative Lidocaine Maintenance Injection on Perioperative Anesthetic Dosage and Occurrence of CPSP in Thoracoscopic Heart Valve Replacement

作　　者：朱状辉[1] 单忠贵[1] 柯少凡[1] 许佳承 ZHU Zhuanghui;SHAN Zhonggui;KE Shaofan;XU Jiacheng(Department of Cardiac Surgery,the First Affiliated Hospital of Xiamen University,Xiamen,Fujian Province,361000 China)

机构地区：[1]厦门大学附属第一医院心外科,福建厦门361000

出　　处：《中外医疗》2023年第13期120-124,共5页China & Foreign Medical Treatment

摘　　要：目的研究术中利多卡因维持注射对胸腔镜下心脏瓣膜置换围术期麻醉药用量及慢性术后疼痛(chronic postoperative pain syndrome,CPSP)发生的影响。方法回顾性分析2019年6月—2021年6月期间于厦门大学附属第一医院行择期胸腔镜下心脏瓣膜置换术的80例患者的病例资料,按照麻醉方法分组,对照组(n=36)术前采取利多卡因诱导麻醉,研究组(n=44)采取利多卡因术前诱导麻醉并术中维持注射。分析比较两组患者围术期情况(术后苏醒、术后指令恢复、首次下床活动时间)、围术期麻醉药物使用剂量、术后苏醒期镇静-躁动评分(SAS)、术后急性疼痛情况及术后3个月CPSP发生率。结果研究组首次下床活动时间(25.32±2.54)h、麻醉药物使用剂量,[丙泊酚(263.01±40.95)mg、瑞芬太尼(0.63±0.16)mg],均优于对照组,差异有统计学意义(t=3.719、5.844、6.614,P<0.05)。术后3个月,研究组CPSP发生率低于对照组,差异有统计学意义(P<0.05)。两组CPSP类型比较,差异无统计学意义(P>0.05)。研究组患者苏醒期SAS评分低于对照组,差异有统计学意义(P<0.05)。研究组苏醒后3、6、12、24 h的VAS评分均低于对照组,差异有统计学意义(P<0.05)。结论术中利多卡因维持注射能提升胸腔镜下心脏瓣膜置换围术期镇痛、镇静效果,并有效预防CPSP发生,有较高临床应用价值。Objective To study the effect of intraoperative lidocaine maintenance injection on the perioperative anesthetic dosage and the occurrence of chronic postoperative pain syndrome(CPSP)in thoracoscopic heart valve replacement.Methods A retrospective analysis was conducted on the case data of 80 patients who underwent elective thoracoscopic heart valve replacement surgery at the First Affiliated Hospital of Xiamen University from June 2019 to June 2021.They were grouped according to anesthesia methods.The control group(n=36)received lidocaine induction anesthesia before surgery,while the study group(n=44)received lidocaine induction anesthesia before surgery and maintained injection during surgery.Analyzed and compared the perioperative situation(postoperative recovery,postoperative command recovery,first time out of bed activity),perioperative anesthetic dosage,postoperative recovery sedation restlessness score(SAS),postoperative acute pain,and 3month postoperative CPSP incidence between two groups of patients.Results The time of getting out of bed for the first time(25.32±2.54)h and the dosage of narcotic drugs[(263.01±40.95)mg of propofol and(0.63±0.16)mg of remifentanil]in the study group were which were better than those in the control group,and the difference was statistically significant(t=3.719,5.844,6.614,P<0.05).Three months after surgery,the incidence of CPSP in the study group was lower than that in the control group,the difference was statistically significant(P<0.05).There was no statistically significant difference in the type of CPSP between the two groups(P>0.05).The SAS score of the study group patients during the recovery period was lower than that of the control group,and the difference was statistically significant(P<0.05).The VAS scores of the study group at 3 h,6 h,12 h,and 24 h after awakening were lower than those of the control group,the difference was statistically significant(P<0.05).Conclusion Intraoperative lidocaine maintenance injection can enhance the perioperative analgesic and se

关 键 词：术后慢性疼痛 利多卡因 胸腔镜 心脏瓣膜置换 麻醉 

分 类 号：R5[医药卫生—内科学]