利多卡因对腹腔镜手术患者术后自主神经功能的影响

Effect of lidocaine on postoperative autonomic nerve function in patients undergoing laparoscopic surgery

  • 摘要:
      目的  探讨静脉输注利多卡因对腹腔镜手术患者术后自主神经功能和恢复的影响。
      方法  将全身麻醉下腹腔镜妇科手术患者70例纳入本研究,随机分为利多卡因组(L组)和对照组(C组)。L组术前静脉推注利多卡因1.5 mg/kg, 术中以1.5 mg/(kg·h)维持, C组给予等量生理盐水。术前、术后第1天和术后第2天动态监测心电图,分析心率变异性(HRV)指标,包括低频功率标准化值(LFnu)、高频功率标准化值(HFnu)、总功率对数值(LogTP)、低频与高频功率比值(LF/HF)、全部窦性RR间期标准差(SDNN)及相邻RR间期差值均方根(RMSSD); 评估术后疼痛评分,检测血清白细胞介素-6(IL-6)浓度并采用恢复质量评定量表(QoR-40)对患者进行随访。
      结果  与C组比较, L组术后第1天LogTP、HFnu、SDNN、RMSSD均较高,而LFnu、LF/HF较低,疼痛评分也较低,差异均有统计学意义(P < 0.05); L组术后第2天的IL-6浓度低于C组, QoR-40评分高于C组,差异均有统计学意义(P < 0.05)。
      结论  利多卡因可稳定腹腔镜手术患者术后交感与副交感神经平衡,利于患者术后恢复。

     

    Abstract:
      Objective  To investigate the effect of lidocaine on perioperative function of autonomic nervous system and recovery in patients undergoing gynecological surgery.
      Methods  A total of 70 patients undergoing laparoscopic gynecological surgery under general anesthesia were randomly divided into lidocaine group (group L) and control group(group C). Group L received intravenous injection of 1.5 mg/kg lidocaine before operation and maintained at 1.5 mg/(kg·h) during operation, while group C received the same amount of normal saline. Electrocardiogram was monitored before operation, 1 day and 2 days after operation to analyze heart rate variability (HRV), including the normalized unit of low-frequency band power (LFnu), the normalized unit of high-frequency band power (HFnu), the log-transformed measure of total-frequency band power (LogTP), 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). Pain score was assessed, and plasma levels of interleukin-6 (IL-6) were determined and the quality of recovery-40 questionnaire (QoR-40) was used to evaluate the quality of recovery.
      Results  Compared with group C, LogTP, HFnu, SDNN, and RMSSD were higher, LFnu and LF/HF were lower, and pain scores were lower in the group L on the first postoperative day (P < 0.05). The levels of plasma IL-6 on the second postoperative day in the group L were significantly lower, and QoR-40 scores were higher than those of the C group (P < 0.05).
      Conclusion  Lidocaine can stabilize the balance of sympathetic and parasympathetic nerves after laparoscopic surgery, which is beneficial to postoperative recovery of patients.

     

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