李永刚

[摘要] 目的 探讨静脉输注利多卡因对阴式子宫切除术后肠麻痹的影响。 方法 选择2011年10月～2013年10月期间我院ASA Ⅰ～Ⅱ级，年龄40～68岁，因子宫肌瘤择期在静脉全麻下行阴式子宫切除术的患者60例，随机将其均分为两组。A组麻醉诱导时推注利多卡因1.5 mg/kg，然后以2 mg/（kg·h）持续泵注至术毕。B组作为对照，未应用利多卡因。记录手术时间、术中失血量、术后排气时间、术后24 h随访时听诊肠鸣音评分及恶心、呕吐发生率。 结果 A组患者术后肠功能恢复较好，恶心、呕吐发生率明显低于B组（P<0.01）。 结论 术中静脉输注利多卡因可以改善阴式子宫切除术患者术后肠麻痹。

[关键词] 术后肠麻痹；静注利多卡因；全麻；阴式子宫切除

[中图分类号] R614.42 [文献标识码] A [文章编号] 1674-4721（2016）02（b）-0110-03

Impact of intravenous Lidocaine on intestinal paralysis after vaginal hysterectomy

LI Yong-gang

Department of Anesthesiology，Beijing Jing Coal Group General Hospital，Beijing 102300，China

[Abstract] Objective To explore the impact of intravenous Lidocaine on intestinal paralysis after vaginal hysterectomy. Methods 60 patients from October 2011 to October 2013 in our hospital，with ASA Ⅰ-Ⅱ degree，40 to 68 years old and selected time to conduct vaginal hysterectomy under intravenous general anesthesia because of uterine fibroids elective，were randomly divided into two groups.Group A was treated with injection Lidocaine 1.5 mg/kg at anesthesia induction and then 2 mg/（kg·h） continued pump injection to the end of operation.Group B was acted as control group and did not application of Lidocaine.Operation time，intraoperative blood loss，postoperative exhaust time，auscultation bowel sounds score at followed-up that 24 h after operation and incidence of nausea and vomit were recorded. Results Postoperative bowel function recovery was better，and incidence of nausea and vomit of patients in group A were obvious less than those in group B （P<0.01）. Conclusion Intravenous Lidocaine during operation can improve the postoperative intestinal paralysis of vaginal hysterectomy patients.

[Key words] Postoperative intestinal paralysis；Intravenous Lidocaine；General anesthesia；Vaginal hysterectomy

美国最新统计显示，因术后肠麻痹需额外支出的医疗费用每年达12.8亿美元[1]，高昂的医疗投入使得人们对术后肠麻痹的预防与管理越来越重视。腹腔手术对胃肠的炎症刺激、应激及麻醉药物的抑制更易引发术后肠麻痹。有研究表明，利多卡因静脉输注具有镇痛、抗炎的特性[2-4]，有助于术后肠功能的早期恢复，但用法和用量差异较大，通常需要应用至术后48 h，这给术后管理带来一定的不便。能否单纯在手术期间输注利多卡因达到改善胃肠功能的目的，目前尚无定论。本文旨在观察利多卡因静脉输注对阴式子宫切除术后肠麻痹的作用。

1 资料与方法

1.1 一般资料

选取我院在2011年10月～2013年10月期间，因子宫肌瘤择期行阴式子宫切除术患者60例，ASA Ⅰ～Ⅱ级，年龄40～68岁。随机将其分成A组（n=30）和B组（n=30）。两组一般资料比较，差异无统计学意义（P>0.05），具有可比性。