利多卡因对妇科腹腔镜手术气腹期间自主神经功能的影响

目的:研究静脉给予利多卡因对妇科腹腔镜手术气腹期间自主神经功能的影响。方法:选取70例全麻下腹腔镜全子宫切除术患者,利用随机数字表法分为两组,利多卡因组诱导时静脉给予利多卡因1.5 mg/kg,术中1.5 mg/(kg·h)维持,对照组给予等量生理盐水。于入手术室后(T0),气管插管时(T1),气腹形成后即刻(T2),气腹形成后10 min(T3)、20 min(T4)、30 min(T5),拔除气管导管时(T6)采集5 min动态心电图进行心率变异性分析,评价自主神经功能,记录术中血压和心率。结果:与对照组比较,利多卡因组T1～T6时交感神经相关指标低频与高频功率比值(LF/HF)和低频功率标准化值(LFnu)降低(P<0.05),副交感相关指标高频功率标准化值(HFnu)升高(P<0.05),T3～T5时总功率对数值(lnTP)、低频功率对数值(lnLF)、全部窦性RR间期标准差(SDNN)降低(P<0.05);T1～T6时平均动脉压降低(P<0.05)。结论:妇科腹腔镜手术静脉输注利多卡因可降低气腹期间交感神经兴奋性,改善自主神经功能状态。

Effect of lidocaine on autonomic nervous function during pneumoperitoneum in gynecological laparoscopic surgery

Objective: To investigate the effect of intravenous lidocaine on autonomic nervous function during pneumoperitoneum in gynecological laparoscopic surgery. Methods: A total of 70 patients with laparoscopic gynecological surgery under general anesthesia were divided into two groups by random number table. In the lidocaine group 1.5 mg/kg of lidocaine was intravenously administered during induction and maintained at 1.5 mg/(kg·h) during surgery. The control group received the same amount of normal saline. A 5 min Holter electrocardiogram was collected for heart rate variability analysis to evaluate autonomic function after admission (T0), intubation (T1), immediately after pneumoperitoneum formation (T2), 10 min after pneumoperitoneum formation (T3), 20 min after pneumoperitoneum formation (T4), 30 min after pneumoperitoneum formation (T5), and extubation (T6). Intraoperative blood pressure and heart rate were also recorded. Results: Compared with control group, the sympathetic related index of the ratio of low to high frequency band powers (LF/HF) and the normalized unit of high frequency band power (LFnu) was lower (P<0.05) while the parasympathetic related index the normalized unit of high frequency band power (HFnu) was higher (P<0.05) in the lidocaine group than that in the control group from T1 to T6. The log transformed measure of total frequency band power (lnTP), the log transformed measure of low frequency band power (lnLF) and the standard deviation of the inter beat interval of normal sinus beats (SDNN) from T3 to T5 were lower than those in control group (P<0.05). In the lidocaine group, the mean arterial pressure was lower from T1 to T6 than that in control group (P<0.05). Conclusion: Intravenous lidocaine infusion in gynecological laparoscopic surgery reduces sympathetic excitability during pneumoperitoneum and improves the status of autonomic nervous function.