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Intraoperative Intravenous Lidocaine Infusion Optimized Postoperative Pain Control and Enhanced Recovery of Gastrointestinal Function after Surgery: A Retrospective Cohort Study
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摘要:
目的 观察腹盆部手术中持续静脉输注利多卡因对术后疼痛管理及胃肠道功能恢复的影响。 方法 回顾性收集并分析2017年1月至2019年5月在北京协和医院接受全麻下腹盆部手术患者的临床资料, 试验组患者在全身麻醉的同时联合静脉输注利多卡因, 对照组采用传统全身麻醉模式。比较两组术后24 h内舒芬太尼的用量、静息及活动状态的疼痛视觉模拟评分(visual analogue score, VAS)、自控镇痛泵按压次数、恶心呕吐及排气情况。 结果 与对照组相比, 试验组术后24 h内舒芬太尼用量和镇痛泵按压次数均减少[(0.0372±0.0137)μg/(kg·h)比(0.0498±0.0447)μg/(kg·h), t=-2.190, P=0.030;(7.4±6.7)次比(11.1±10.6)次, t=-2.257, P=0.027], 术后24 h内的静息及活动状态疼痛VAS评分≤ 3分者比例均更高(97.0%比85.5%, χ2=3.938, P=0.047;68.7%比47.3%, χ2=5.710, P=0.017), 肠道排气率更高(26.9%比5.5%, χ2=9.717, P=0.002), 但恶心、呕吐发生率未见统计学差异。 结论 腹盆部手术术中输注利多卡因可能有助于术后疼痛管理, 加速胃肠道功能恢复。 Abstract:Objective The aim of this study was to investigate the effect of intraoperative intravenous lidocaine infusion on pain control and the recovery of gastrointestinal function after abdominal pelvic surgery. Methods Clinical data of patients who underwent abdominal pelvic surgery under general anesthesia from January 2017 to May 2019 in Peking Union Medical College Hospital were retrospectively collected and analyzed. The patients of the control group received traditional general anesthesia, while those of the experimental group received the intravenous infusion of lidocaine based on general anesthesia. The total amount of sufentanil within the postoperative 24 h, pain visual analogue score (VAS), the number of deliveries, incidence of nausea andvomiting, the propertion of patients with intestinal passing gas were compared. Results The amount of sufentanil and the number of deliveries in the experimental group were lower than those in the control group[(0.0372±0.0137)μg/(kg·h) vs. (0.0498±0.0447)μg/(kg·h), t=-2.190, P=0.030; 7.4±6.7 vs. 11.1±10.6, t=-2.257, P=0.027]. Compared with that in the control group, the proportion of the pain VAS ≤ 3 at rest and active state in the experimental group were higher(97.0% vs. 85.5%, χ2=3.938, P=0.047; 68.7% vs. 47.3%, χ2=5.710, P=0.017), as well as the proportion of patients with intestinal passing gas(26.9% vs. 5.5%, χ2=9.717, P=0.002); there was no statistical difference in the incidence of nausea and vomiting. Conclusion Intraoperative intravenous lidocaine infusion may be helpful to optimize postoperative pain control and enhance the recovery of gastrointestinal function after surgery. -
Key words:
- lidocaine /
- enhanced recovery after surgery /
- multimodal analgesia
利益冲突 无 -
表 1 两组腹盆部手术患者一般临床资料比较
指标 对照组(n=55) 试验组(n=67) t值/χ2 P值 年龄(x±s，岁)(n=100) 49.6±15.3 52.8±14.9 -1.164 0.247 BMI(x±s，kg/m2) 22.9±3.5 23.2±3.9 -0.406 0.685 性别[n(%)] 0.058 0.810 女性 30(54.5) 38(56.7) 男性 25(45.5) 29(43.3) ASA分级[n(%)] 0.007 0.935 Ⅰ~Ⅱ级 49(89.1) 60(89.6) Ⅲ级 6(10.9) 7(10.4) 手术时间(x±s，h) 194.9±83.6 179.0±83.0 1.053 0.295 麻醉时间(x±s，h) 215.9±85.1 205.9±84.0 0.004 0.516 手术种类[n(%)] 1.818 0.178 开服 22(40.0) 35(52.2) 微创 33(60.0) 32(47.8) BMI：体质量指数，ASA：美国麻醉医师学会 
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表 2 两组腹盆部手术患者术后24h内舒芬太尼自控镇痛情况比较
指标 对照组(n=55) 试验组(n=67) t值 P值 舒芬太尼用量[x±s, μg/(kg·h)] 0.049 8±0.044 7 0.037 2±0.013 7 -2.190 0.030 自主按压次数(x±s, 次) 11.1±10.6 7.4±6.7 -2.257 0.027
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表 3 两组腹盆部手术患者术后24 h静息及活动状态疼痛视觉模拟评分比较[n(%)]
指标 对照组(n=55) 试验组(n=67) χ2值 P值 静息状态 3.938 0.047 ≤3分 47(85.5) 65(97.0) ＞3分 8(14.5) 2(3.0) 活动状态 5.710 0.017 ≤3分 26(47.3) 46(68.7) ＞3分 29(52.7) 21(31.3)
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表 4 两组腹盆部手术患者术后24h胃肠道功能恢复情况比较[n(%)][n(%)]
指标 对照组(n=55) 试验组(n=67) χ2值 P值 恶心 3.335 0.551 有 14(25.5) 14(20.9) 无 41(74.5) 53(79.1) 呕吐 0.859 0.354 有 3(5.5) 8(11.9) 无 52(94.5) 59(88.1) 排气 9.717 0.002 有 3(5.5) 18(26.9) 无 52(94.5) 49(73.1)
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