神经阻滞联合静脉低剂量利多卡因输注用于老年结直肠癌患者术后镇痛时的血药浓度变化及安全性研究  

A study on the blood concentration changes and safety of nerve block combined with low-dose intravenous lidocaine infusion for postoperative analgesia in elderly colorectal cancer patients

作　　者：周萌萌 伍靖雯 落伍拉静 徐艳[1] 周莉[1] 姜春玲[1] ZHOU Mengmeng;WU Jingwen;LUOWU Lajing;XU Yan;ZHOU Li;JIANG Chunling(Department of Anesthesiology,West China Hospital,Sichuan University,Chengdu 610000,China;West China School of Nursing,Sichuan University,Chengdu 610000,China)

机构地区：[1]四川大学华西医院麻醉科,四川成都610000 [2]四川大学华西护理学院,四川成都610000

出　　处：《中国实验诊断学》2025年第4期373-377,共5页Chinese Journal of Laboratory Diagnosis

基　　金：四川省科技计划项目(2023YFH0074,2023ZYD0168);吴阶平医学基金(320.6750.2022-05-3)。

摘　　要：目的初步探讨罗哌卡因腹横肌平面(transversus abdominis plane,TAP)阻滞联合低剂量利多卡因静脉输注,用于接受结直肠癌根治术的老年患者术后镇痛时,利多卡因及罗哌卡因的血药浓度变化特征及其联合应用的安全性。方法纳入60岁以上接受结直肠癌根治术的患者15例,所有患者均接受罗哌卡因TAP阻滞及静脉低剂量利多卡因输注(1.5 mg/kg/h)至手术结束,术后连接含有利多卡因的静脉自控镇痛泵。检测开始用药10 min至24 h内11个时间点的利多卡因和罗哌卡因血药浓度,同时通过监测术中脑电图、术中及术后心电图、局麻药中毒相关症状等,评估患者围术期是否出现局麻药中毒反应。结果本次研究共纳入分析15例患者的163份血液样本。发现利多卡因血药浓度于开始输注后90 min至3 h达峰值,峰值浓度范围为2.19~4.90μg/mL;罗哌卡因的峰值浓度则出现在TAP阻滞后10 min至60 min,峰值浓度范围为0.87~2.59μg/mL;其中1例低白蛋白血症的患者,罗哌卡因血药浓度于TAP阻滞后45 min与60 min超过正常上限2.2μg/mL。所有患者均未报告局麻药中毒症状,脑电图及心电图监测亦未发现局麻药中毒相关表现。结论罗哌卡因TAP阻滞联合静脉低剂量利多卡因输注用于老年结直肠癌手术的术后镇痛时,血清白蛋白正常者利多卡因及罗哌卡因的血药浓度均在安全范围;所有患者围术期均未出现局麻药中毒相关反应。Objective To preliminarily explore the blood concentration changes of lidocaine and ropivacaine,as well as the safety of combined transversus abdominis plane(TAP)block with low-dose intravenous lidocaine infusion for postoperative analgesia in elderly patients undergoing radical colorectal cancer surgery.Methods A total of 15patients aged over 60years undergoing radical colorectal cancer surgery were included.All patients received ropivacaine TAP block and low-dose intravenous lidocaine infusion(1.5mg/kg/h)till the end of surgery followed by a lower dose of intravenous lidocaine infusion.Plasma concentrations of lidocaine and ropivacaine were measured at 11time points,from 10minutes to 24hours after the initiation of treatment.Intraoperative electroencephalogram(EEG),intraoperative and postoperative electrocardiogram(ECG),and symptoms related to local anesthetic toxicity were monitored to assess the occurrence of local anesthetic toxicity during the perioperative period.Results A total of 163blood samples from 15 patients were analyzed.The results showed that the peak blood concentration of lidocaine occurred 90minutes to 3 hours after infusion,with a concentration range of 2.19~4.90μg/mL.The peak concentration of ropivacaine occurred 10~60minutes after TAP block,with a concentration range of 0.87~2.59μg/mL.In one patient with hypoalbuminemia,the ropivacaine concentration exceeded the normal upper limit of 2.2μg/mL at 45minutes and 60minutes post-TAP block.No patients reported symptoms of local anesthetic toxicity,and EEG and ECG monitoring did not reveal any signs of local anesthetic toxicity.Conclusion When used for postoperative analgesia in elderly colorectal cancer patients,ropivacaine TAP block combined with low-dose intravenous lidocaine infusion results in blood concentrations of lidocaine and ropivacaine within safe limits in patients with normal serum albumin levels.No patients experienced local anesthetic toxicity during the perioperative period.

关 键 词：罗哌卡因 利多卡因 腹横肌平面阻滞 血药浓度 老年人 

分 类 号：R614[医药卫生—麻醉学]