摘要
目的:探讨术中持续静脉输注利多卡因对扁桃体切除手术患儿围术期丙泊酚用量和术后疼痛、拔管反应等围术期不良事件的影响。方法:将80例择期行扁桃体切除术患儿随机分为利多卡因组和对照组,每组40例。利多卡因组麻醉诱导前5 min给予利多卡因1.5 mg/kg静脉注射,随后持续泵注利多卡因1.5 mg/(kg·h)至手术结束。对照组输注等体积生理盐水。记录术中丙泊酚输注速率,术后阿片类药物用量,术前及术后1、3、6、24、48 h患儿的Wong-Baker疼痛评分,术前及拔管后即刻、1、5、10 min时患者平均动脉压(MAP)和心律(HR)以及拔管后不良事件发生情况。结果:与对照组相比,利多卡因组术中丙泊酚用量明显减少(P<0.05);术后1、3、6、24、48 h利多卡因组Wong-Baker疼痛评分明显低于对照组(P<0.05),且6 h疼痛最剧烈;相比于对照组,利多卡因组术后阿片类药物用量明显减少(P<0.05),拔管后即刻、1、5、10 min患儿MAP及HR血流动力学更为平稳(P<0.05),24 h内恶心呕吐情况明显减少(P<0.05),住院时间缩短(P<0.05),但其苏醒及拔管时间、拔管后其余不良反应无差异;两组均未见利多卡因毒性症状。结论:术中持续输注利多卡因有利于减少围术期丙泊酚用量,减轻小儿扁桃体切除术术后疼痛,减少阿片类药物用量,减少术后24 h内恶心呕吐发生率及住院时间。
Objective:To investigate the effect of intraoperative continuous intravenous infusion of lidocaine on perioperative propofol dosage and adverse events sunch as postoperative pain and extubation reaction in children underwent tonsillectomy.Methods:Eighty children undergoing elective tonsillectomy were rando mly divided into lidocaine group and control group,with 40 cases in each group.In the lidocaine group,1.5 mg/kg lidocaine was given intravenously 5 minutes before induction of anesthesia,and then 1.5 mg/(kg·h)lidocaine was continuously pumped until the end of operation.The control group was infused with an equal volume of normal saline.The intraoperative propofol infusion rate,the postoperative opioid dose,the scores of Wong-Baker pain before and 1,3,6,24,48 hours after operation,preoperative,the average arterial pressure(MAP)and heart rate(HR)before and 0,1,5,10 minutes after extubation,the adverse events after extubation were recorded.Results:Compared with the control group,the intraoperative propofol dosage in the lidocaine group was significantly lower(P<0.05);the Wong-Baker pain scores 1,3,6,24,48 hours after operation in the lidocaine group were significantly lower than those in the control group(P<0.05),and the pain was the most severe 6 hours after operation;the dosage of opioids in the lidocaine group was significantly reduced after operation(P<0.05),the MAP and HR 0,1,5,10 minutes after extubation were more stable(P<0.05),the nausea and vomiting was significantly reduced within 24 hours(P<0.05),the hospital stay was shortened(P<0.05),but there was no difference in the time of wake-up and extubation,and other adverse reactions after extubation.There were no symptoms of lidocaine toxicity in either group.Conclusion:Intraoperative continuous infusion of lidocaine is beneficial to reduce the dosage of propofol in perioperative period,reduce the postoperative pain and opioid dosage in children with tonsillectomy,and reduce the incidence of nausea and vomiting and hospitali-zation within 24 hours after operation.
作者
董欣昌
杨瑞
DONG Xinchang;YANG Rui(Graduate School of Xi’an Medical College,Xi’an 710068)
出处
《陕西医学杂志》
CAS
2020年第6期741-744,共4页
Shaanxi Medical Journal
基金
陕西省自然科学基金资助项目(2018JQ8023)。
