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| 利多卡因对妇科腹腔镜手术患者术后早期自主神经和肠道运动功能的影响 |
| Effect of lidocaine on early postoperative autonomic nerve and bowel motor function in patients undergoing gynecological laparoscopic surgery |
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| DOI：10.12089/jca.2022.08.004 |
| 中文关键词: 利多卡因 自主神经 肠道运动功能 术后恢复质量 |
| 英文关键词: Lidocaine Autonomic nervous system Bowel motor function Quality of postoperative recovery |
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| 中文摘要: |
目的 探讨利多卡因对妇科腹腔镜手术患者术后早期自主神经和肠道运动功能的影响。
方法 选择全麻下腹腔镜全子宫双附件切除术患者56例，年龄30～64岁，BMI 18～25 kg/m2，ASA Ⅰ或Ⅱ级。将患者随机分为两组：利多卡因组（L组）和对照组（C组），每组28例。L组麻醉诱导时静脉推注利多卡因1.5 mg/kg，术中泵注利多卡因1.5 mg·kg-1·h-1至手术结束，C组给予等量生理盐水。两组麻醉诱导与维持方案相同。记录术前1 d、术后第1、2天心率变异性（HRV）指标，包括总功率对数值（LogTP）、低频功率标准化值（LFnu）、高频功率标准化值（HFnu）、低频与高频功率比值（LF/HF）、全部窦性RR间期的标准差（SDNN）及相邻RR间期差值均方根（RMSSD）。采用酶联免疫吸附法（ELISA）测定术前1 d、术后第1、2天血清IL-6浓度。记录术后第1、2天40项术后恢复质量（QoR-40）评分。记录术后首次肠鸣音、肛门排气、排便和耐受固体食物时间。
结果 与C组比较，L组术后第1天LogTP、HFnu、SDNN、RMSSD明显升高（P<0.05），LFnu和LF/HF明显降低（P<0.05），术后第1、2天IL-6浓度明显降低（P<0.05），QoR-40恢复质量评分明显增高（P<0.05），术后首次肠鸣音、肛门排气、排便和耐受固体食物时间明显缩短（P<0.05）。
结论 术中静脉输注利多卡因可降低妇科腹腔镜手术患者术后早期的交感神经兴奋性，保护副交感活性，促进术后早期肠道运动功能的恢复。 |
| 英文摘要: |
Objective To investigate the effect of lidocaine on early postoperative autonomic nervous system and bowel motor function in patients undergoing gynecological laparoscopic surgery.
Methods Fifty-six patients, aged 30-64 years, BMI 18-25 kg/m2, ASA physical status Ⅰ or Ⅱ, scheduled for laparoscopic gynecological surgery under general anesthesia were randomly divided into two groups: lidocaine group (group L) and control group (group C), 28 patients in each group. Group L was injected 1.5 mg/kg bolus of lidocaine during induction followed by an infusion at 1.5 mg·kg-1·h-1 until the end of surgery. Group C received the same amount of saline. In addition, both groups took the same anesthetic induction and maintenance regimen. Heart rate variability (HRV) parameters were analyzed 1 day before surgery, on the first and the second day after surgery, including the log-transformed measure of total-frequency band power (LogTP), the normalized unit of low-frequency band power (LFnu), the normalized unit of high-frequency band power (HFnu), the ratio of low to high frequency band powers (LF/HF), the standard deviation of the inter-beat-interval of normal sinus beats (SDNN) and the root mean square of successive difference of successive intervals (RMSSD). Serum IL-6 concentration was measured by enzyme-linked immunosorbent assay (ELISA) 1 day before surgery, on the first and the second day after surgery, and the quality of recovery-40 questionnaire (QoR-40) scores was used to assess the quality of recovery on the first and second day after surgery. The time of postoperative first bowel sounds, flatus, defecation, and time to tolerate solid food were recorded.
Results Compared with group C, LogTP, HFnu, SDNN, and RMSSD in group L were significantly increased (P < 0.05), LFnu and LF/HF were significantly decreased on the first day after surgery in group L (P < 0.05), IL-6 plasma level were significantly decreased on the first and second day after surgery (P < 0.05), and QoR-40 scores were significantly increased in group L (P < 0.05), and the recovery time of bowel sounds, the time of first exhaust, defecation, and the time to tolerate solid food were significantly shorter in group L (P < 0.05).
Conclusion Intraoperative intravenous infusion of lidocaine can reduce sympathetic excitability and protect parasympathetic activity in the early postoperative period in patients undergoing gynecological laparoscopic surgery, promoting early postoperative bowel motor function recovery. |
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