静脉输注利多卡因对腹腔镜全子宫切除术后疼痛及早期康复的影响

摘要

Objective To evaluate the effect of intravenous lidocaine on postoperative pain and acute rehabilitation after laparoscopic hysterectomy.Methods Ninety-six patients scheduled for lapa-roscopic hysterectomy under general anesthesia were randomized into 2 groups (n = 48 ).In test group,lidocaine 1.5 mg/kg was administered at induction,then with a continously infusing rate of 2 mg·kg-1 ·h-1 until the end of surgery.In control group,saline was instead.Record the resting and coughing pain scores at 6,12,24 and 48 h after surgery,morphine consumption during the first 48 h, time to first flatus,6 min walk test (6MWT)result,and side effects such as dizzy,nausea and vomi-ting.Results Resting VAS scores at 6,12 and 24 h postoperatively were lower in test group than in control group (P <0.05).Coughing VAS scores in test group were lower than in control group at all time points (P <0.05).The morphine consumption was lower in test group than in control group (P<0.05).Time to first flatus was earlier in test group than in control group (P <0.05 ).6MWT at day 4 and 5 were significantly enhanced in test group (P <0.05 ).Conclusion Intravenous lidocaine can reduce postoperative pain scores and morphine consumption,as well as improve early rehabilita-tion after laparoscopic hysterectomy.%目的：观察静脉输注利多卡因对腹腔镜全子宫切除术后疼痛及早期康复的影响。方法96例择期行腹腔镜全子宫切除术的患者,随机分为研究组和对照组,每组48例。研究组麻醉诱导时静脉给予2%利多卡因1.5 mg/kg,随后连续静脉输注利多卡因2 mg·kg-1·h-1直至手术结束,对照组以生理盐水代替利多卡因。记录术后6、12、24和48 h 静息与咳嗽状态下 VAS 评分,48 h内吗啡累积使用量,术后第一次排气时间,术后第3~5天每天六分钟步行测试距离,以及术后恶心、呕吐、眩晕等不良反应情况。结果术后6、12和24 h 静息状态下研究组 VAS 评分明显低于对照组(P <0.05)；术后48 h 内各时点咳嗽状态下研究组 VAS 评分明显低于对照组(P <0.05)。与对照组比较,研究组48 h 内吗啡累积使用量明显减少(P <0.05),术后第一次排气时间明显缩短(P <0.05),步行测试距离明显延长(P <0.05)。两组术后不良反应差异无统计学意义。结论静脉输注利多卡因可以减轻腹腔镜全子宫切除术后疼痛,减少吗啡用量,促进患者早期康复。