术中利多卡因持续静脉泵入对胸腔镜肺叶切除术患者阿片类用量及术后恢复的影响

摘要

目的 探讨胸腔镜肺叶切除术持续静脉泵入利多卡因能否减少患者术中阿片类用量及改善术后恢复.方法 本研究为单中心随机对照研究,入选北京协和医院择期行胸腔镜肺癌切除术的患者60例.采用随机数字法,将患者随机分为利多卡因静脉泵入组及对照组.患者经口双腔气管插管,术中全静脉维持.利多卡因组诱导给予利多卡因1 mg/kg,后予利多卡因2 mg/ (kg·h)持续泵入,至手术结束拔管前停药.比较两组患者的一般情况、术前检查、术中情况及用药,以及术后恢复情况.结果 两组患者的一般情况与术前检查差异无统计学意义(P均＞0.05).利多卡因组患者术中舒芬太尼的用量明显减少[(32.3±7.5)μg比(40.9±10.2) μg,P＜0.001],对照组术中更多患者使用艾司洛尔(P=0.010),利多卡因组术后24 h内恶心发生率明显降低(P =0.045).两组患者术后恢复情况差异无统计学意义(P均＞0.05).结论 胸腔镜肺叶切除术患者术中持续静脉泵入利多卡因,可减少术中阿片类药物的用量,并减少术后恶心的发生,无不良反应及中毒现象.%Objective To investigate whether continuous intravenous intraoperative lidocaine infusion can reduce the opioids dosage and improve postoperative recovery in patients undergoing video-assisted thoracoscopic (VATS) lobectomy.Methods Totally 60 patients undergoing VATS lobectomy were enrolled in this single-center randomized controlled study.The patients were equally randomized into lidocaine continuous pumping group (lidocaine group) and control group by computer-based random numbers.The patients had double-lumen catheter intubation,and total intravenous anesthesia was administrated intraoperatively.In the lidocaine group,patients continuously received intravenous pumping of lidocaine [2 mg/(kg · h)] after a loading doses (1 mg/kg) until the end of the operation.We recorded the basic characteristics,preoperative examination,intraoperative medications,and postoperative recovery of both groups.Results The basic characteristics and preoperative examination findings were comparable between these two groups (all P ＞ 0.05).Compared with the control group,the intraoperative sufentanil consumption significantly decreased in the lidocaine group [(32.3 ± 7.5) μg vs.(40.9 ± 10.2) μg,P ＜ 0.001].Significantly more patients were given esmolol intraoperatively in the control group to lower heart rate (P =0.010).The incidence of postoperative nausea within 24 hours was significantly lower in the lidocaine group (P =0.045).There was no significant difference between the two groups in postoperative recovery (all P ＞ 0.05).Conclusion Intravenous continuous pumping of lidocaine during operation can reduce opioids consumption and lower the incidence of postoperative nausea without extra adverse or toxic reaction in patients undergoing VATS lobectomy.