目的 探讨静脉注射利多卡因对老年男性腹腔镜前列腺癌根治术后加速康复的影响.方法 选取2023年9月至12月宁波大学附属李惠利医院拟行腹腔镜前列腺癌根治术的78例患者为研究对象,根据随机数字表法将其分为对照组和实验组,每组各39例.实验组患者于麻醉诱导时静脉注射利多卡因1.5mg/kg,并以2mg/(kg·h)微泵注射至术毕,对照组患者注射等量生理盐水.记录术中丙泊酚、瑞芬太尼用量.比较两组患者的视觉模拟评分法(visual analogue scale,VAS)评分、术后麻醉恢复室(postanesthesia care unit,PACU)停留时间、首次肛门排气和首次排便时间、首次下床活动时间、住院时间、术后48h内患者静脉自控镇痛(patient-controlled intravenous analgesia,PCIA)有效按压次数、舒芬太尼追加次数及用量、40项恢复质量(quality of recovery-40,QoR-40)量表评分、术后48h内不良反应发生情况.结果 实验组患者的术中丙泊酚和瑞芬太尼用量、术后48h内PCIA有效按压次数、舒芬太尼追加次数、舒芬太尼用量均显著少于对照组(P＜0.05);实验组患者术后2h、6h、12h、24h、48h的VAS评分均显著低于对照组(P＜0.05);实验组患者的术后PACU停留时间、首次肛门排气时间、首次排便时间、首次下床活动时间、住院时间均显著短于对照组(P＜0.05);实验组患者术后48h内的恶心呕吐发生率显著低于对照组(P＜0.05),两组患者术后均未出现嗜睡、呼吸抑制、严重心动过缓等不良反应;术后48h,实验组患者QoR-40量表的舒适度、情绪、疼痛评分及总分均显著高于对照组(P＜0.05).结论 在老年男性腹腔镜前列腺癌根治术中,静脉输注利多卡因可减少围手术期麻醉药物用量,同时减轻术后疼痛和不良反应,促进患者术后恢复.
Application of lidocaine in enhanced recovery after radical prostatectomy
Objective To investigate the effect of intravenous lidocaine on enhanced recovery of elderly men after laparoscopic radical prostatectomy.Methods A total of 78 patients who planned to undergo laparoscopic radical prostatectomy in Affiliated Lihuili Hospital of Ningbo University from September to December 2023 were selected as study objects,and they were divided into control group and experimental group according to random number table method,with 39 patients in each group.Experimental group received intravenous lidocaine of 1.5mg/kg during induction of anesthesia,followed by micropump injection at a rate of 2mg/(kg·h),and control group was injected with an equal amount of normal saline.The intraoperative dosage of propofol and remifentanil was recorded.Visual analogue scale(VAS)score,postoperative postanesthesia care unit(PACU)residence time,first anal exhaust time,first defecation time,first getting out of bed activity time,length of hospital stay,number of effective patient-controlled intravenous analgesia(PCIA)compressions within 48h after surgery,number and dosage of sufentanil addition,quality of recovery-40(QoR-40)scale score,and occurrence of adverse reactions within 48h after surgery were compared between two groups.Results The intraoperative dosage of propofol and remifentanil,the number of effective PCIA compression,the number of sufentanil addition and the amount of sufentanil in postoperative 48h in experimental group were significantly lower than those in control group(P＜0.05).The VAS scores of experimental group at 2h,6h,12h,24h and 48h were significantly lower than those of control group(P＜0.05).The PACU residence time,first anal exhaust time,first defecation time,first getting out of bed activity time and hospital stay time of experimental group were significantly shorter than those of control group(P＜0.05).The incidence of nausea and vomiting in experimental group was significantly lower than that in control group within postoperative 48h(P＜0.05),and no adverse reactions such as drowsiness,respiratory depression,and severe bradycardia occurred in both groups.48h after surgery,the comfort,emotion,pain scores and total scores of QoR-40 in experimental group were significantly higher than those in control group(P＜0.05).Conclusion In elderly men undergoing laparoscopic radical prostatectomy,intravenous infusion of lidocaine can reduce the amount of perioperative anesthetic drugs,reduce postoperative pain and adverse reactions,and promote postoperative recovery.
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