静脉注射利多卡因对妇科手术患者氢吗啡酮镇痛效果影响的研究

The effect of intravenous lidocaine on the analgesic effect of hydromorphone in patients undergoing gynecological surgery

摘要:

目的 实时评估妇科手术麻醉诱导前使用利多卡因与氢吗啡酮后镇痛效果的变化。方法 选择全麻下行妇科择期手术患者90例,经纳入排除标准筛选,共收集77例,其中实验组(L组)38例,对照组(C组)39例。L组先后静脉注射浓度为1%的利多卡因(剂量为1.5mg/kg)和浓度为0.2mg/ml的氢吗啡酮(剂量为0.015mg/kg),C组先后静脉注射生理盐水(等利多卡因容量)和浓度为0.2mg/ml的氢吗啡酮(剂量为0.015mg/kg)。记录在给药前(T₁)、给予利多卡因或生理盐水后(T₂)和氢吗啡酮后(T₃)的压痛痛阈(pressure pain threshold,PPT)及耐痛阈(pressure pain tolerance,PTO)；观察并记录T₂到T₃期间NTI开始变化值及到达开始变化值的时间;记录给药后两组患者的不良反应。结果 两组患者一般情况比较无统计学差异(P>0.05);与C组相比,L组T₃与T₁时的差值,M与S probe的PPT变化值明显增多(P<0.05)；两组患者在T₂至T₃期间的镇静深度及速度比较均无统计学差异(P>0.05);两组患者在T₁、T₂、T₃三个时间点的RR与SpO₂比较均无统计学差异(P>0.05)；两组患者在使用氢吗啡酮前,是否使用利多卡因,不良反应发生率无统计学差异(P>0.05)。结论 在妇科择期手术麻醉诱导前静脉注射利多卡因和盐酸氢吗啡酮注射液后,镇痛作用增强。同时,本研究所选利多卡因及盐酸氢吗啡酮注射液的剂量均安全可靠。

Abstract:

Objective Real-time assessment of the analgesic effect of lidocaine and hydromorphone. Method 90 patients of gynecological elective surgery under general anesthesia were selected, and 77 patients were finally included according to the inclusion and exclusion criteria. They were divided into two groups randomly,lidocaine group(group L, n=38) and control group(group C, n=39).The group L received intravenous lidocaine(1.5mg/kg bolus) and hydromophone(0.015mg/kg bolus),the group C received 0.9% saline(the same volume of lidocaine) and hydromophone(0.015mg/kg bolus).The pressure pain threshold(PPT) and the pressure pain tolerance(PTO) were measured before administration(T₁),after lidocaine or saline administration(T₂) and hydromorphone administration(T₃) in the operating room. Observe and record the NTI start change value during T2 to T3 and the time to reach the start change value. Adverse reactions were observed after administration of drugs.Results There was no significant difference between the groups in age, weight, BMI and clinical baseline(P>0.05). Compared with group C, the change in PPT of M and S probe between T₃ and T₁ ingroup L are significantly increased. (P<0.05).There was no significant difference in the depth of sedation and the change rate between the two groups from T₂ to T₃ (P> 0.05).There was no significant difference of RR and SpO₂ between the two groups at T_1, T₂ and T₃ (P> 0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups. Conclusion The results, by real-time detection, the analgesic effect was enhanced after intravenous injection of lidocaine and hydromorphone, the dose of hydromorphone and lidocaine was safe and reliable.