利多卡因对老年腹腔镜胆囊切除术患者插管、拔管血流动力学及术后疼痛的影响

摘要

Objective:To investigate the effect of lidocaine on hemodynamics and postoperative pain in elderly patients undergoing laparoscopic cholecystectomy (LC).Methods:A total of 122 patients,who underwent LC operation in the 101st Hospital of PLA from February 2012 to December 2016,were selected and randomly divided into lidocaine group (62 cases) and control group (60 cases).All the patients were given intravenous infusion of midazolam 0.06 mg/kg,propofol 2.6 mg/lcg,sufentanil 2 μg/kg and CIS atracurium 0.2 mg/kg for anesthesia induction;The tracheal intubation was used for mechanical ventilation.Lidocaine group was given intravenous lidocaine,while the control group was given saline.The intubation and extubation hemodynamics and postoperative pain of the two groups were observed after operation.Results:The VAS scores of all the patients did not reach 4 points at each time point;the scores of VAS in the lidocaine group were lower than those in the control group at T2 and T3 (P＜0.05),and there was no significant difference in the VAS scores between the two groups at T1,T4 and T5 (P＞0.05).The VAS scores of the two groups at the time ofT2 and T3 were significantly higher than those of the T1,while the VAS scores at the time ofT4 and T5 were lower than those ofTl (P＜0.05).The mean arterial pressure (MAP) and heart rate (HR) in the lidocaine group were lower than those in the control group at t2,t3,t4,t5 and t6 (P＜0.05),there was no significant difference in pulse oxygen saturation (SpO2) between the two groups at each time poin(P＞0.05);the respiratory rate (RR) in the lidocaine group was significantly lower than that in the control group at t2 and t3 (P＜0.05).Conclusion:The analgesic effect of lidocaine in the postoperative intubation and extubation of elderly patients with LC is better.It has little influence on the hemodynamics of patients,and it is beneficial to promote the postoperative rehabilitation of patients,which is worthy of promotion in clinical practice.%目的:探讨利多卡因对老年腹腔镜胆囊切除术(LC)患者插管、拔管血流动力学及术后疼痛的影响.方法:选择2012年2月～2016年12月期间在我院行LC手术患者122例为研究对象,采用随机数字表法将其分为利多卡因组(62例)和对照组(60例),所有患者麻醉诱导为静脉推注咪达唑仑0.06 mg/kg,丙泊酚2.6 mg/lcg,舒芬太尼2μg/kg和顺阿曲库胺0.2 mg/kg,采用气管插管行机械通气,利多卡因组患者术中静脉给予利多卡因,对照组患者给予生理盐水,观察两组患者术后插管、拔管血流动力学及术后疼痛情况.结果:所有患者在各时间点VAS评分均未达到4分,利多卡因组患者在T2、T3时刻VAS评分均低于对照组(P＜0.05),T1、T4、T5时刻两组VAS评分无统计学差异(P＞0.05).两组患者在T2、T3时刻VAS评分显著高于T1时刻,而T4、T5时刻均低于T1时刻(P＜0.05),利多卡因组患者平均动脉压(MAP)、心率(HR)在t2、t3、t4、t5、t6时刻均低于对照组(P＜0.05);两组患者脉搏氧饱和度(SpO2)各个时刻均无统计学差异(P＞0.05);利多卡因组患者呼吸频率(RR)在t2、t3时刻均显著低于对照组(P＜0.05).结论:利多卡因在老年LC患者手术插管、拔管的镇痛效果较好,对患者血流动力学的影响较小,有利于促进患者术后康复,值得在临床应用推广.