利多卡因静脉输注对视频辅助胸腔镜手术患者术后恢复质量的影响  

Effect of lidocaine intravenous infusion on the quality of postoperative recovery in patients undergoing video-assisted thoracoscopic surgery

作　　者：朱牡丹[1] 张春兰 施舟 沈方明 ZHU Mudan;ZHANG Chunlan;SHI Zhou;SHEN Fangming(Department of Anesthesiology,Tongling People's Hospital,Tongling 244000,China)

机构地区：[1]安徽省铜陵市人民医院麻醉科,244000 [2]东南大学附属中大医院麻醉科

出　　处：《临床麻醉学杂志》2025年第4期358-363,共6页Journal of Clinical Anesthesiology

基　　金：蚌埠医学院科技项目(自然重点)(2023byzd035)。

摘　　要：目的探讨利多卡因持续输注对视频辅助胸腔镜手术患者术后恢复质量的影响。方法选择择期全麻下行视频辅助胸腔镜手术患者90例,男50例,女40例,年龄18~80岁,BMI 18.5~30.0 kg/m^(2),ASAⅠ—Ⅲ级。采用随机数字表法将患者分为两组:利多卡因组(L组,n=46)和生理盐水组(C组,n=44)。L组在麻醉诱导前10 min缓慢静脉注射利多卡因1.5 mg/kg,插管后以2.0 mg·kg^(-1)·h^(-1)持续泵注至手术结束,C组予以等量生理盐水输注。记录麻醉诱导前、诱导后、插管后、切皮后和拔管后HR和MAP,双腔支气管导管置入时间,术中丙泊酚和瑞芬太尼消耗量,单肺通气期间低氧发生率,苏醒时间、PACU停留时间和术后住院时间,术后2、6和12 h静息和活动时VAS疼痛评分,术后24、48 h恢复质量(QoR-40)评分,术后补救镇痛率,PACU期间恶心呕吐、寒战、谵妄和术后48 h恶心呕吐发生率,术后7 d内肺部并发症发生率。结果与C组比较,L组插管后、切皮后和拔管后HR明显减慢、MAP明显降低(P<0.05),双腔支气管导管置入时间明显缩短、术中丙泊酚、瑞芬太尼消耗量明显降低(P<0.05),苏醒时间、PACU停留时间明显缩短(P<0.05),术后2、6 h静息时VAS疼痛评分和术后2 h活动时VAS疼痛评分明显降低(P<0.05),术后24、48 h QoR-40评分明显升高(P<0.05),术后补救镇痛率明显降低(P<0.05)。两组PACU期间恶心呕吐、寒战、谵妄和术后48 h恶心呕吐发生率差异无统计学意义,术后7 d内肺部并发症发生率差异无统计学意义。结论静脉输注利多卡因可以改善视频辅助胸腔镜手术患者术后恢复质量,使术中血流动力学更加稳定,术中丙泊酚、瑞芬太尼消耗量降低,术后疼痛减轻,并且更快地苏醒和转回病房。Objective To explore the effect of lidocaine continuous infusion on the quality of postoperative recovery in patients undergoing video-assisted thoracoscopic surgery.Methods Ninety patients were selected to undergo video-assisted thoracoscopic surgery under elective general anaesthesia,50 males and 40 females,aged 18-80 years,BMI 18.5-30.0 kg/m^(2),and ASA physical statusⅠ-Ⅲ.The patients were divided into two groups by random number table method:the lidocaine group(group L,n=46)and the saline group(group C,n=44).Group L was injected with 1.5 mg/kg of lidocaine slowly intravenously 10 minutes before induction of anaesthesia,and after intubation,it was pumped continuously at 2.0 mg·kg^(-1)·h^(-1)until the end of the operation,while group C was infused with an equal amount of saline.Changes in HR and MAP before induction of anaesthesia,after induction,after intubation,after surgical skinning and after extubation,placement time of double lumen bronchial tube,intraoperative consumption of propofol and remifentanil,incidence of hypoxia during one-lung ventilation,time of awakening,time of stay in the PACU and length of postoperative hospital stay,and VAS pain scores at rest and activity 2,6,and 12 hours after surgery were recorded.Quality of recovery(QoR-40)scores at 24 and 48 hours,the rate of postoperative remedial analgesia,incidence of nausea and vomiting,chills,delirium during PACU and incidence of nausea and vomiting 48 hours postoperatively,and incidence of pulmonary complications within 7 days postoperatively were recorded.Results Compared with group C,group L had significantly slower HR and lower MAP after intubation,skin incision and extubation(P<0.05),significantly shorter double-lumen bronchial catheter placement,significantly lower intraoperative propofol and remifentanil consumption(P<0.05),significantly shorter wake-up time and PACU stay(P<0.05),significantly lower postoperative 2 and 6 hours resting VAS pain scores,and significantly lower postoperative 2 hour active VAS pain scores(P<0.05),and sig

关 键 词：利多卡因 视频辅助胸腔镜手术 疼痛管理 术后恢复质量 肺部并发症 

分 类 号：R614[医药卫生—麻醉学]