摘要目的 探讨围手术期静脉输注利多卡因对腹腔镜胆囊手术术后疼痛、胃肠功能康复及血清中IL-6、IL-8、IL-1ra水平的影响. 方法 80名择期行腹腔镜胆囊切除手术的患者采用随机对照表法分为两组(每组40例):利多卡因静脉输注组(L组),诱导前静脉缓慢注射1.5 mg/kg利多卡因,随后以2 mg· kg-1·h-1的速度持续静脉输注至手术结束;等量生理盐水空白对照组(C组),诱导及术中给予相同容积的生理盐水.麻醉方法及多模式镇痛采用标准化方案.本研究的首要观察指标为术后疼痛评分(VAS评分)、阿片类药物的使用量、术后第1次排气时间及第1次排便时间.次要观察指标为48 h内不同时点血清中IL-6、IL-8及IL-1ra的水平. 结果 71例患者完成试验.静脉输注利多卡因能明显减轻术后疼痛,术后2、6 h VAS评分L组低于C组(P＜0.05);利多卡因明显降低术后24 h的芬太尼使用量[L组(98±16) μg、C组(187±20) μg,P＜0.05];利多卡因明显促进术后胃肠功能早期恢复,术后第1次排气时间和术后第1次排便时间L组均低于C组(P＜0.05).静脉输注利多卡因可明显抑制手术引起的IL-6和IL-8水平的增高(P＜0.05). 结论 静脉输注利多卡因可明显改善腹腔镜胆囊手术患者的术后恢复,降低腹腔镜手术引起的IL-6、IL-8过度释放.

abstractsObjective This randomized controlled study was conducted to assess the effect of perioperative intravenous lidocaine infusion on pain,bowel function,and levels of serum IL-6,IL-8 and IL-lra in patients subjected to larparoscopic cholecystectomy.Methods Eighty patients undergoing laparoscopic cholecystectomy were randomly allocated to receive intravenous infusion of lidocaine (bolus injection of 1.5 mg/kg lidocaine for induction of anesthesia,then a continuous infusion of 2 mg ·kg-1 ·h-1 until the end of surgery) or an equal volume of saline.Anesthesia and multimodal perioperative analgesia were standardized.Pain scores (VAS),consumption of opioid drugs,time to first flatus,and time to first bowel movement were measured after surgery.The levels of serum IL-6,IL-8 and IL-lra were also measured at scheduled times within 48 h.Results Seventy-one of eighty recruited patients finished the survey.The two groups of patients showed similar demographic profile.Lidocaine infusion significantly reduced pain intensity 2 h and 6 h after surgery (P＜0.05) and total fentanyl consumption 24 h after surgery [lidocaine (98+16) μg vs placebo (187+20) μg,P＜0.05].Time to first flatus passage and time to first bowel movement were also significantly shorter in patients received lidocaine(P＜0.05).The post-operative levels of serum IL-6 and IL-8 in the lidocaine group were lower than those in the control group.Conclusions This study suggests that perioperative infusion of lidocaine improves postoperative recovery and attenuates the excessive release of serum IL-6 and IL-8 following laparoscopic cholecystectomy.