手术麻醉中静脉持续应用利多卡因对老年结直肠肿瘤手术患者术后肠道功能恢复及谵妄发生的影响

目的:探讨静脉持续应用利多卡因对结直肠肿瘤手术老年患者术后肠道功能恢复及谵妄（POD）发生的影响。方法:选取我院2020年05月至2021年06月行结直肠肿瘤手术的老年患者60例，随机分为2组，利多卡因组（L组，n=30)和生理盐水组（C组，n=30)。L组在麻醉诱导前10 min给予1％利多卡因1.5 mg/kg（0.15 mL/kg）静脉缓慢推注，用药持续约10 min，使用微量泵继续输注1％利多卡因0.15 mL/(kg·h)的速度持续静脉泵注至缝皮结束。C组在诱导前和麻醉维持时使用等容量生理盐水静脉用药。用药结束后开始麻醉，术后接静脉镇痛泵进行术后镇痛。记录患者第一次排便时间，通过疼痛数字评分法（NRS）对术后第一天和第二天进行疼痛评分。用简易精神状态评价量表（MMSE）法评估术前1天、术后1天和术后3天POD。结果:两组术前一般情况无明显差异，无局麻药中毒发生；术后L组第一次排便时间明显早于C组（P＜0.05）。术后第1天，C组患者静脉自控镇痛（PCIA）泵按压次数（7.5±2.8）次显著高于L组（2.8±1.1）次（P<0.05）。与C组比较，术后第1天和第3天L组MMSE评分显著高于C组（P<0.05）；与术前1天MMSE评分比较，术后第 1天和第3天C组MMSE显著下降（P<0.05），L组术前1天的MMSE评分和术后第1天、术后第3天比较，无明显差异(P>0.05)。术后第1天和第3天C组POD发生率显著高于L组（P<0.05）。结论:静脉持续应用利多卡因可以降低结直肠肿瘤手术老年患者术后谵妄的发生率，促进肠道功能的恢复。

Effect of continuous intravenous lidocaine on postoperative recovery of intestinal function and delirium in elderly patients undergoing colorectal tumor surgery

Objective:To investigate the effect of continuous intravenous lidocaine on postoperative delirium(POD) in elderly patients undergoing colorectal tumor surgery.Methods:60 elderly patients who underwent colorectal tumor surgery from May 2020 to June 2021 in our hospital were randomly divided into 2 groups,lidocaine group(Group L,n=30) and normal saline group(Group C,n=30).In group L,1% lidocaine 1.5 mg/kg(0.15 mL/kg) was slowly administ rated by a intravenous bolus 10 min before induction of anesthesia,and the medication lasted for about 10 min.The micro pump was used to continue infusion of 1% lidocaine 0.15 mL/(kg·h) continues intravenous pumping to the end of the suture.Group C received intravenous medication with equal volume of normal saline before induction and during the maintenance of anesthesia.Anesthesia was performed after the medication,and an intravenous analgesic pump was connected for postoperative analgesia.Record the time of the patient's first bowel movement,pain was scored on the first and second day after the operation by the numerical pain score(NRS).The simple mental state evaluation scale(MMSE) method was used to evaluate POD on the first day before operation,the fisrt day after operation,and the 3th day after operation.Results:There was no significant difference under the general conditions between the two groups before the operation,and no local anesthetic poisoning occurred.After the operation,the first defecation time of the group L was significantly earlier than that of the group C(P<0.05).On the first postoperative day,the number of PCIA pump compressions was significantly higher in the group C(7.5±2.8 times) than that in the group L(2.8±1.1 times)(P<0.05).The MMSE score of the group L was significantly higher than that of group C on the 1st and 3rd day after operation(P<0.05).Compared with the MMSE score of the first day before operation,group C on the 1st and 3rd day after operation MMSE decreased significantly(P<0.05).There was no significant difference in the scores of patients among the group L(P>0.05).The incidence of POD in the group C was significantly higher than that in the group L on the 1st and 3rd day after operation(P<0.05).Conclusion:Continuous intravenous lidocaine can decrease the incidence of postoperative delirium in the elderly patients undergoing colorectal tumor surgery and promote the recovery of the intestinal function.