不同剂量利多卡因对老年患者腹腔镜下结肠癌根治术后早期恢复质量的影响

Effect of different doses of lidocaine on quality of early recovery after laparoscopic radical resection of colon cancer in elderly patients

中文关键词: 利多卡因  老年  结肠癌根治术  恢复质量

英文关键词: Lidocaine  Aged  Radical surgery for colon cancer  Quality of recovery

中文摘要:

      
目的 观察不同剂量利多卡因对老年患者腹腔镜下结肠癌根治术后早期恢复质量的影响。

方法 选择2021年11月至2022年9月择期行腹腔镜下结肠癌根治术的老年患者59例，年龄65～85岁，BMI 18～28 kg/m²，ASA Ⅰ—Ⅲ级。采用随机数字表法将患者分为三组：生理盐水组（C组，n=20）、利多卡因1 mg·kg^-1·h^-1维持量组（L1组，n=20）和利多卡因3 mg·kg^-1·h^-1维持量组（L3组，n=19）。麻醉诱导前30 min L1组和L3组于10 min内静脉泵注利多卡因负荷量1.5 mg/kg，自手术开始时泵注至手术结束分别静脉持续泵注维持量1 mg·kg^-1·h^-1和3 mg·kg^-1·h^-1。C组给予等量生理盐水。记录麻醉时间、手术时间、术中出血量、补液量、丙泊酚用量和瑞芬太尼用量。记录术后2、6、12、24、48 h静息时VAS疼痛评分及术后24 h内PCA有效按压次数。记录术前24 h及术后24 h的白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）浓度、QoR-15评分，并计算ΔQoR-15评分。记录术后首次下床活动时间、术后首次肛门排气时间、术后住院时间以及利多卡因相关不良反应发生情况。

结果 与C组比较，L1组和L3组术中瑞芬太尼用量、术后24 h内PCA有效按压次数明显减少，术后2、6、12、24 h静息时VAS疼痛评分、术后24 h IL-6和TNF-α浓度明显降低，术后24 h QoR-15评分明显升高，ΔQoR-15评分明显降低，术后首次下床活动时间明显缩短（P＜0.05）；L3组术中丙泊酚用量明显减少，术后首次肛门排气时间和术后住院时间明显缩短，恶心呕吐发生率明显降低（P＜0.05）。与L1组比较，L3组术中丙泊酚和瑞芬太尼用量、术后24 h内PCA有效按压次数明显减少，术后24 h IL-6和TNF-α浓度明显降低，术后24 h QoR-15评分明显升高，ΔQoR-15评分明显降低，术后首次肛门排气时间和术后住院时间明显缩短（P＜0.05）。三组无一例发生利多卡因相关不良反应。

结论 老年患者腹腔镜下结肠癌根治术中，利多卡因以1.5 mg/kg负荷量静脉注射，继以3 mg·kg^-1·h^-1维持量持续泵注至术毕可以促进术后早期恢复，提高恢复质量，且未发生利多卡因相关不良反应。

英文摘要:

      
Objective To observe the effect of different doses of lidocaine on the quality of early recovery after radical laparoscopic colon cancer.

Methods Fivety-nine elderly patients, aged 65-85 years, BMI 18-28 kg/m², ASA physical status Ⅰ-Ⅲ, selected from November 2021 to September 2022 for laparoscopic radical colonic cancer, were divided into three groups using a random number table method: saline (group C, n = 20), lidocaine 1 mg·kg^-1·h^-1 maintenance dose group (group L1, n = 20), and lidocaine 3 mg·kg^-1·h^-1 maintenance dose group (group L3, n = 19). Lidocaine 1.5 mg/kg was given within 10 minutes in groups L1 and L3 30 minutes before anesthesia induction, and the continuous intravenous pumping maintenance was 1 mg·kg^-1·h^-1 and 3 mg·kg^-1·h^-1 from the beginning of the operation to the end of the operation. Group C was given the same amount of saline. Anesthesia time, operation time, intraoperative blood loss, fluid replacement amount, propofol dosage and remifentanil dosage were recorded. The resting VAS pain scores 2, 6, 12, 24, and 48 hours after surgery and the number of effective PCA compressions within 24 hours after surgery were recorded. The concentration of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α) and QoR-15 scores 24 hours before surgery and 24 hours after surgery were recorded, and ΔQoR-15 scores were calculated. The time of first getting out of bed, the time of first anal exhaust after surgery, the length of postoperative hospital stay, and the occurrence of lidocaine-related adverse reactions were recorded.

Results Compared with group C, the dosage of remifentanil and the number of PCA compression within 24 hours after surgery were significantly reduced, the VAS pain scores at rest 2, 6, 12, and 24 hours after surgery, the concentrations of IL-6 and TNF-α 24 hours after surgery were significantly decreased, the score of QoR-15 24 hours after surgery was significantly increased, ΔQoR-15 score was significantly decreased, the time of first postoperative ambulation was significantly shortened in groups L1 and L3 (P < 0.05), the amount of propofol was significantly reduced, the time of first postoperative anal exhaust and postoperative hospital stay were significantly shortened, the incidence of nausea and vomiting was significantly decreased in group L3 (P < 0.05). Compared with group L1, the intraoperative dosage of propofol and remifentanil and the number of PCA compressions within 24 hours after surgery were significantly reduced, the concentrations of IL-6 and TNF-α were significantly decreased 24 hours after surgery, the QoR-15 score was significantly increased and ΔQoR-15 score was significantly decreased, the time of first postoperative anal exhaust and postoperative hospital stay were significantly shortened in group L3 (P < 0.05). No lidocaine-related adverse reactions occurred in the three groups.

Conclusion During laparoscopic radical operation of colon cancer in elderly patients, lidocaine was injected intravenously with 1.5 mg/kg load followed by 3 mg·kg^-1·h^-1 maintenance volume continued pumping till the end of the operation, which promotes early postoperative recovery and improves recovery quality without lidocaine-related adverse reactions．