2022 年第 6 期 第 17 卷

静脉输注利多卡因对腔镜甲状腺手术患者术后气道并发症的影响

Effect of intravenous lidocaine on postoperative airway complications in patients undergoing endoscopic thyroid surgery

作者：周丽丽李雪萍陈剑牟崇明丁红艳梅雅静赵健宗

英文作者：Zhou Lili Li Xueping Chen Jian Mu Chongming Ding Hongyan Mei Yajing Zhao Jianzong

单位：广东省东莞东华医院麻醉科，东莞523110

英文单位：Department of Anesthesiology Dongguan Donghua Hospital Guangdong Province Dongguan 523110 China

关键词：利多卡因；腔镜甲状腺手术；气道并发症

英文关键词：Lidocaine;Endoscopicthyroidsurgery;Airwaycomplications thyroidsurgery

• 摘要：

• 目的 观察静脉输注利多卡因对腔镜甲状腺手术患者术后气道并发症的影响。方法 选择2019年5月至2020年5月在广东省东莞东华医院行腔镜甲状腺手术的患者60例。按照随机数字表法分为利多卡因组和对照组，各30例。2组在麻醉诱导前、麻醉诱导和麻醉维持时的其他方法一致，不同处在于利多卡因组患者麻醉诱导时静脉输注利多卡因1.5 mg/kg(标准体质量)，为避免患者出现局部麻醉药物中毒，最大使用量为150 mg，随后以2 mg/（kg·h）的速度持续输注利多卡因，直至拔除气管导管。对照组则对应在麻醉诱导期和维持期输注等容量的0.9%氯化钠注射液。比较2组患者术后气道并发症(呛咳和咽喉痛)发生情况、镇痛药物使用情况，血清炎症因子水平和不良反应发生情况。结果 利多卡因组术后30 min和24 h时气道并发症(呛咳和咽喉痛)发生程度轻于对照组，差异均有统计学意义（均P＜0.05）。术后利多卡因组舒芬太尼使用量少于对照组［（13.8±2.0）μg比（36.8±4.2）μg］，差异有统计学意义(P＜0.001)。手术结束时和术后2、24 h，利多卡因组血清中炎症因子白细胞介素6和肿瘤坏死因子α水平均低于对照组,差异均有统计学意义（均P＜0.05）。2组术后恶心呕吐发生率比较差异无统计学意义（P＞0.05）。结论 静脉输注利多卡因对腔镜甲状腺手术患者可减少术后气道呛咳和咽喉痛的发生，减少术后镇痛药物的使用及炎症因子的释放，且未增加术后恶心呕吐发生率。

• Objective To observe the effect of intravenous lidocaine on postoperative airway complications in patients undergoing endoscopic thyroid surgery. Methods Sixty patients who underwent endoscopic thyroid surgery in Dongguan Donghua Hospital, Guangdong Province from May 2019 to May 2020 were selected. They were randomly divided into lidocaine group and control group, with 30 cases in each group. The patients in the lidocaine group received 1.5 mg/kg lidocaine (standard body mass) intravenous injection, and other methods of the two groups were the same before anesthesia induction, during anesthesia induction and anesthesia maintenance. In order to avoid local anesthetic poisoning, the maximum dosage was 150 mg, and then continue to inject lidocaine at the rate of 2 mg/(kg·h) until the tracheal tube was removed. The control group was infused with equal volume of 0.9% sodium chloride injection during anesthesia induction and maintenance. The incidence of postoperative airway complications (choking cough and sore throat), the use of analgesic drugs, the level of serum inflammatory factors and the incidence of adverse reactions were compared between the two groups. Results   The incidence of airway complications (choking cough and sore throat) in lidocaine group at 30 min and 24 h after operation were better than those in the control group(all P＜0.05). The dosage of sufentanil in lidocaine group was less than that in control group［（13.8±2.0）μg vs （36.8±4.2）μg］(P＜0.001). At the end of operation, 2 and 24 h after operation, the serum levels of inflammatory factors interleukin-6 and tumor necrosis factor-α in lidocaine group were lower than those in the control group(all P＜0.05). There was no significant difference in the incidence of postoperative nausea and vomiting between the two groups (P＞0.05). Conclusions  Intravenous lidocaine can reduce postoperative airway choking and sore throat, the dosage of postoperative analgesics and the release of inflammatory factors in patients undergoing laparoscopic thyroid surgery, and does not increase postoperative nausea and vomiting.