利多卡因联合咪达唑仑、顺式阿曲库铵在腹腔镜胆囊切除术麻醉诱导观察

摘要/Abstract

摘要： 目的探讨利多卡因联合咪达唑仑、顺式阿曲库铵在腹腔镜胆囊切除术麻醉诱导效果。方法选取2019年7月~2022年1月安徽中医药大学第一附属医院收治的90例腹腔镜胆囊切除术患者,根据随机数表法将其分为对照组和试验组,每组45例,对照组给予咪达唑仑、顺式阿曲库铵、舒芬太尼和丙泊酚麻醉诱导,试验组在对照组的基础上给予利多卡因麻醉诱导。对比两组首次肠鸣音恢复时间和首次肛门排气时间、术后不同时刻视觉模拟量表（VAS）评分、术后2 h血管紧张素Ⅱ（AngⅡ）表达水平和术后2 h肾上腺素（E）、去甲肾上腺素（NE）、皮质醇（Cor）的水平、T淋巴亚群CD8⁺、CD4⁺、CD3⁺、自然杀伤（NK）细胞水平以及CD4⁺/CD8⁺比值、不良反应率。结果试验组首次肠鸣音恢复时间和首次肛门排气时间均短于对照组（P<0.05）;试验组术后拔管时刻以及术后4、8、12、24、48 h静息VAS评分均低于对照组（P<0.05）,且两组组内不同时刻组内VAS评分比较,差异有统计学意义（P<0.05）;两组术前AngⅡ、E、NE、Cor指标水平比较,差异无统计学意义（P>0.05）,两组术后2 h上述各项指标水平均有所上升,但试验组均低于对照组（P<0.05）;两组麻醉诱导前30 min CD8⁺、CD4⁺、CD3⁺、NK、CD4⁺/CD8⁺指标比较,差异无统计学意义（P>0.05）,两组术后24 h上述指标均呈下降趋势,且试验组CD4⁺、CD3⁺、NK与CD4⁺/CD8⁺指标水平均高于对照组（P<0.05）,两组CD8⁺水平比较,差异无统计学意义（P>0.05）;两组呼吸抑制、低血压、苏醒期躁动等不良反应率比较,差异无统计学意义（P>0.05）。结论利多卡因联合咪达唑仑、顺式阿曲库铵用于腹腔镜胆囊切除术麻醉诱导,可缩短首次肠鸣音恢复时间和首次肛门排气时间,减轻术后疼痛感,减轻机体应激反应,提高免疫功能,且具有一定的安全性,值得临床应用。

关键词: 利多卡因, 咪达唑仑, 顺式阿曲库铵, 腹腔镜胆囊切除术, 麻醉效果

Abstract: Objective To investigate the anesthetic effect of lidocaine combined with midazolam and cis-atracurium in laparoscopic cholecystectomy. Methods A total of 90 patients with laparoscopic cholecystectomy who were admitted to the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine from July 2019 to January 2022 were selected and divided into expermental group (n=45) and control group (n=45) according to the random table method. The control group was given midazolam, cisatracurium, sufentanil and propofol for anesthesia induction. The experimental group was given lidocaine for anesthesia induction on the basis of the control group. The recovery time of the first bowel sound and the first anal exhaust time, visual analogue scale (VAS) score at different postoperative time, the expression level of angiotensin Ⅱ(Ang Ⅱ) at 2 h after surgery, the levels of adrenaline (E), norepinephrine (NE), cortisol (Cor), T lymphocyte subsets CD8⁺, CD4⁺, CD3⁺, and self were compared between the two groups NK cell level, CD4⁺/CD8⁺ ratio and adverse reaction rate. Results The recovery time of the first bowel sound and the first anal exhaust time in the experimental group were shorter than those in the control group (P<0.05). It was lower than the control group (P<0.05), and the VAS scores between the two groups at different times were compared,the difference was statistically significant (P<0.05); the levels of Ang II, E, NE, and Cor were compared between the two groups before operation,the difference was not statistically significant (P>0.05). The levels of the above indexes increased at 2 h, but the experimental group was lower than the control group (P<0.05); the comparison of CD8⁺, CD4⁺, CD3⁺, NK, CD4⁺/CD8⁺ indexes 30 minutes before anesthesia induction between the two groups,the difference was not statistically significant (P>0.05), the above indexes in both groups showed a downward trend 24 hours after operation, and the levels of CD4⁺, CD3⁺, NK and CD4⁺/CD8⁺ indexes in the experimental group were higher than those in the control group (P<0.05), and the CD8⁺ levels in the two groups were compared,the difference was not statistically significant (P>0.05). There was no statistically differencein the adverse reaction rate of respiratory depression, hypotension, restless hess during awakening between the experimental group and the control group (P>0.05). Conclusion Lidocaine combined with midazolam and cis-atracurium for anesthesia induction in laparoscopic cholecystectomy can shorten the recovery time of the first bowel sound and the time of the first anal exhaust, relieve postoperative pain, relieve the body’s stress response, improve immune function. Meanwhile, it has a certain safety, and is worthy of clinical application.

Key words: lidocaine, midazolam, cis-atracurium, laparoscopic cholecystectomy, anesthesia effect

中图分类号:

R614

尹莹莹. 利多卡因联合咪达唑仑、顺式阿曲库铵在腹腔镜胆囊切除术麻醉诱导观察[J]. 中华养生保健, 2022, 40(22): 153-157.

YIN Ying-ying. Anesthetic Effect of Lidocaine Combined with Midazolam and Cis-Atracurium in Laparoscopic Cholecystectomy[J]. ZHONGHUA YANGSHENG BAOJIAN, 2022, 40(22): 153-157.

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