[1]张 锋,刘 鹤.右美托咪定复合利多卡因对腹腔镜手术患者术后自主神经功能及肠道运动功能的影响[J].医学信息,2023,36(01):117-121.[doi:10.3969/j.issn.1006-1959.2023.01.023]
　ZHANG Feng,LIU He.Effects of Dexmedetomidine Combined with Lidocaine on Postoperative Autonomic Nerve Function and Intestinal Motor Function in Patients Undergoing Laparoscopic Surgery[J].Journal of Medical Information,2023,36(01):117-121.[doi:10.3969/j.issn.1006-1959.2023.01.023]
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右美托咪定复合利多卡因对腹腔镜手术患者术后自主神经功能及肠道运动功能的影响()
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医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
36卷
期数:
2023年01期
页码:
117-121
栏目:
论著
出版日期:
2023-01-01

文章信息/Info

Title:
Effects of Dexmedetomidine Combined with Lidocaine on Postoperative Autonomic Nerve Function and Intestinal Motor Function in Patients Undergoing Laparoscopic Surgery
文章编号:
1006-1959（2023）01-0117-05
作者:
张 锋; 刘 鹤
（1.徐州医科大学附属医院麻醉科，江苏 徐州 221000； 2.湖州市中心医院麻醉科，浙江 湖州 313003）
Author(s):
ZHANG Feng; LIU He
(1.Department of Anesthesiology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,Jiangsu,China;2.Department of Anesthesiology,Huzhou Central Hospital,Huzhou 313003,Zhejiang,China)
关键词:
右美托咪定; 利多卡因; 腹腔镜; 自主神经功能; 肠道运动功能
Keywords:
Dexmedetomidine; Lidocaine; Laparoscopic; Autonomic nerve function; Intestinal motor function
分类号:
R614
DOI:
10.3969/j.issn.1006-1959.2023.01.023
文献标志码:
A
摘要:
目的 探讨右美托咪定复合利多卡因对腹腔镜手术患者术后自主神经功能及肠道运动功能的影响。方法 选取2019年1月-2022年6月于本院行腹腔镜下全子宫切除术的患者78例，按照单双号法分为对照组与观察组，各39例。两组均采用全凭静脉麻醉，麻醉方案均采用丙泊酚＋瑞芬太尼，观察组麻醉诱导前静脉泵注利多卡因与右美托咪定，对照组麻醉诱导前静脉泵注相同体积生理盐水，术后均根据患者疼痛耐受情况给予曲马多口服。比较两组术前及术后1、2 d心脏自主神经功能[心率变异性（HRV）：总功率频段（TP）、低频段（LF）、高频段（HF）、低频段与高频段比值（LF/HF）]、应激指标[皮质醇（COR）、肾上腺素（E）]、炎性指标[白细胞介素-6（IL-6）、C反应蛋白（CRP）]水平；比较两组术中丙泊酚及瑞芬太尼用量、苏醒时疼痛程度[视觉模拟评分法（VAS）]、术后48 h曲马多用量、术后肠道运动功能（出现肠鸣音时间、肛门排气时间、排便时间与首次进食固态食物时间）恢复情况及不良反应发生率。结果 观察组术后1 d LF低于术前，且低于对照组（P＜0.05）；对照组术后1 d HF、TP低于术前，且低于观察组（P＜0.05）；对照组术后1 d LF/HF高于术前，且高于观察组（P＜0.05）；两组术后1 d与术后2 d COR、E、IL-6、CRP水平均高于术前，但观察组术后1 d COR、E、IL-6、CRP水平低于对照组（P＜0.05）；观察组术中丙泊酚及瑞芬太尼用量、苏醒时VAS评分及术后48 h曲马多用量均低于对照组（P＜0.05）；观察组术后出现肠鸣音时间、肛门排气时间、排便时间与首次进食固态食物时间均短于对照组（P＜0.05）；两组不良反应发生率比较，差异无统计学意义（P＞0.05）。结论 右美托咪定复合利多卡因能有效改善腹腔镜手术患者术后自主神经功能紊乱，减轻应激与炎性反应，促进肠道功能恢复，镇痛效果好，安全性良好。
Abstract:
Objective To investigate the effect of dexmedetomidine combined with lidocaine on postoperative autonomic nerve function and intestinal motor function in patients undergoing laparoscopic surgery.Methods Seventy-eight patients who underwent laparoscopic total hysterectomy in the hospital from January 2019 to June 2022 were selected and divided intocontrol group and observation group according to the odd-even number method, with 39 cases in each group. Both groups were treated with total intravenous anesthesia with propofol and remifentanil, and the observation group was intravenously pumped with lidocaine and dexmedetomidine before anesthesia induction, and the control group was intravenously pumped with the same volume of normal saline before anesthesia induction, and both groups were given oral tramadol according to the pain tolerance of patients after surgery. Cardiac autonomic nerve function [heart rate variability (HRV): total power frequency band (TP), low frequency band (LF), high frequency band (HF), low frequency-to-high frequency ratio (LF/HF)], stress indicators [cortisol (COR), epinephrine (E)] and inflammatory indicators [interleukin-6 (IL-6), C-reactive protein (CRP)] before surgery and at 1 day and 2 days after surgery, intraoperative dosages of propofol and remifentanil, pain degree [Visual Analogue Scale (VAS)] during recoveryand dosage of tramadol at 48 hours after surgery, recovery of postoperative intestinal motor function (onset time of bowel sounds, anal exhaust time, defecation time and time of first eating solid food) and incidence rate of adverse reactions were compared between the two groups.Results LF in observation group at 1 day after surgery was lower than that before surgery and that in control group (P<0.05). The HF and TP in control group at 1 day after surgery were lower than those before surgery, and the two indicators in observation group were higher than those in control group (P<0.05). The levels of COR, E, IL-6 and CRP in the two groups at 1 day and 2 day after surgery were higher than those before operation, but the levels of COR, E, IL-6 and CRP in the observation group at 1 day after surgery were lower than those in the control group (P<0.05). The intraoperative dosage of propofol and remifentanil, VAS score at recovery and the dosage of tramadol 48 h after surgery in the observation group were lower than those in the control group (P<0.05). The time of bowel sounds, anal exhaust time, defecation time and the time of first eating solid food in the observation group were shorter than those in the control group (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05).Conclusion Dexmedetomidine combined with lidocaine can effectively improve the postoperative autonomic nerve dysfunction, relieve the stress and inflammatory response, and promote the recovery of intestinal functionin patients undergoing laparoscopic surgery, and it has good analgesic effect and good safety.

参考文献/References:

[1]张静,邓卓,李玢,等.腹腔镜与开腹手术治疗子宫内膜癌的疗效比较[J].现代肿瘤医学,2019,27(13):2368-2372.[2]Raimondi F,Colombo R,Costantini E,et al.Effects of laparoscopic radical prostatectomy on intraoperative autonomic nervous system control of hemodynamics[J].Minerva Anestesiol,2017,12:1265-1273.[3]Spencer NJ,Hu H.Enteric nervous system: sensory transduction, neural circuits and gastrointestinal motility[J].Nat Rev Gastroenterol Hepatol,2020,17(6):338-351.[4]赵楠溪,曹学照,王俊.利多卡因持续静脉输注对腹腔镜结直肠手术患者术后疼痛的影响[J].中国医科大学学报,2019,48(2):136-139. [5]肖水亮,薛荣亮.右美托咪定在下肢骨折患者麻醉中的应用效果及其对炎症因子的影响[J].医学信息,2022,35(7):118-120. [6]孙兵,车晓明.视觉模拟评分法(VAS)[J].中华神经外科杂志,2012,28(6):645.[7]许瑞,吕洁萍.不同负荷剂量右美托咪定对老年后腹腔镜患者心率变异性及血流动力学的影响[J].山西医科大学学报,2017,48(11):1186-1190.[8]李菲菲,孟祎凡,黄雯,等.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[J].临床麻醉学杂志,2022,38(8):801-805.[9]陈茂桂,王林,李敏,等.利多卡因对腹腔镜手术患者术后自主神经功能的影响[J].实用临床医药杂志,2022,26(6):95-99.[10]莫志武,裴润萍,李朝阳,等.诱导麻醉术前应用咪达唑仑和右美托咪啶对心率变异性的影响[J].解放军预防医学杂志,2019,37(2):41-42,45.[11]李振,吕甲林,丁锡金.腹腔镜手术治疗结肠癌合并肠梗阻疗效观察[J].海南医学,2020,31(12):1552-1555.[12]熊利华,伍学民,潘翔军.腹腔镜与开腹式结直肠癌术前术后血清C-反应蛋白、白细胞介素-6、内皮素、一氧化氮检测的临床探讨[J].中国卫生检验杂志,2018,28(8):973-975,978.[13]张努,徐连生.右美托咪定联合利多卡因静脉输注对腹腔镜全子宫切除术患者氧化应激水平及炎性反应的影响[J].中国医药导报,2018,15(10):95-98,134.[14]胡小庆.右美托咪定对行腹腔镜根治术的老年前列腺癌患者术后认知功能和炎性因子水平的影响[J].解放军医药杂志,2018,30(4):33-36. [15]马甫营,王胜斌,居霞,等.右美托咪定注射液联合利多卡因注射液用于腹腔镜全子宫切除术患者的临床研究[J].中国临床药理学杂志,2021,37(15):1985-1988.[16]夏道林,黄艳明,张大勇,等.低剂量利多卡因静脉泵注对腹腔镜胆囊切除术中丙泊酚用量和术后疼痛及胃肠道功能的影响[J].江苏医药,2018,44(2):215-217.[17]陈波,彭文勇,屠文龙,等.右美托咪定对腹腔镜胃癌根治术患者氧化应激、糖代谢及术后镇痛的影响[J].中华全科医学,2018,16(3):395-397,451. [18]庞晓燕,王宇鑫,王向.评价右美托咪定用于全身麻醉患者的镇静效应及其对全身麻醉药物的节俭作用[J].中国药物与临床,2018,18(6):946-948.[19]郭忠娟,刘颖,刘妍.妇科腹腔镜手术患者术后胃肠功能紊乱的影响因素分析[J].中国妇幼保健,2021,36(10):2346-2349.[20]刘超磊,苑雪娇,孙章楠,等.右美托咪定联合腹横肌平面阻滞对腹腔镜结直肠手术患者术后胃肠道功能的影响[J].实用医学杂志,2021,37(23):3026-3030.

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更新日期/Last Update: 1900-01-01