利多卡因用于老年患者术后镇痛的临床观察

目的：观察利多卡因复合芬太尼静脉输注用于老年患者术后镇痛的效果及不良反应。方法：择期老年手术患者40例,ASAⅡ～Ⅲ级。其中男25例,女15例,年龄66～79岁,食道癌和肺切除10例,腹腔镜胆囊切除12例,乳腺癌根治4例,前列腺切除11例,肾切除3例。将40例患者随机分为A、B两组,每组20例。两组患者术后镇痛均使用一次性恒速输注泵（速度4mL/h,容量200mL）。A组镇痛泵的配方为利多卡因50mg/kg＋芬太尼10μg/kg＋昂丹司琼0.2mg/kg＋生理盐水共200mL;B组镇痛泵的配方的为芬太尼20μg/kg＋昂丹司琼0.2mg/kg＋生理盐水共200mL。A、B两组患者分别在手术结束前10min给予利多卡因1mg/kg和芬太尼1μg/kg并随后接镇痛泵。两组患者的麻醉诱导和维持均相同。记录术后2、4、8、12、24h疼痛视觉模拟评分（VAS评分）,镇静评分、不良反应。结果：两组患者镇痛效果均较满意,各时间点VAS评分组间比较无显著差异（P〉0.05）。B组的恶心、呕吐、过度镇静、呼吸抑制和心动过缓等不良反应的发生率明显多于A组（P〈0.05或P〈0.01）。结论：芬太尼复合利多卡因静脉持续输注用于老年患者术后镇痛效果满意,不良反应较少。

The clinical analgesic effects of lidocaine combined with fentanyl in elderly patients undergoing surgery

Objective: To investigate the clinical analgesic effects of lidocaine combined with fentanyl in elderly patients undergoing surgery.Methods:Forty ASAⅡ～Ⅲ patients(25 male,15 female) aged 66～79 yr were randomly divided into two equal groups according to the composition of analgesic solution: group A(lidocaine combined with fentanyl) and group B(fentanyl only).All patients in two groups used intravenous infusion pump as the postoperative analgesic equipment.In group A,200mL analgesic solution contained lidocaine 50 mg/kg+fentanyl 10 μg/kg+ondansetron 0.2 mg/kg+physiological saline solution.In group B,200mL analgesic solution contained fentanyl 20 μg/kg+ondansetron 0.2 mg/kg+physiological saline solution.Patients in group A received 1 mg/kg lidocaine and patients in group B received fentanyl 1μg/kg 10 min by the end of operation.All patients were induced with etomidate 0.2～0.3mg/kg,fentanyl 3～4μg/kg and syn-atracurium 0.1～0.15mg/kg and anesthesia was maintained with inhalation 1%～3% sevoflurane,pumping propofol 4～6mg·kg-1·h-1,remifentanil 5～10μg·kg-1·h-1 and syn-atracurium 0.1～0.2mg·kg-1·h-1.Keep the hemodynamics stable and the same muscle relaxation in two groups.The VAS score,sedation score,the side effects were recorded at 2,4,8,12,24 h after operation.Results:The analgesic effect was favorable in two groups.There was no significant difference between group A and group B in the VAS score and the Ramsay score(P>0.05).Compared with group A,the side effects(nausea,emesia,over sedative,respiratory depression,bradycardia) were significantly decreased than those in group B(P<0.05 or P<0.01).Conclusion:Intravenous analgesia of lidocaine combined with fentanyl offers favorable analgesic effect and can reduce the side effects in old patients undergoing surgery.