【罂粟摘要】利多卡因、右美托咪定及其联合输注对腹腔镜下子宫切除术后恶心呕吐发生率的影响:一项随机对照试验
利多卡因、右美托咪定及其联合输注对腹腔镜下子宫切除术后恶心呕吐发生率的影响:一项随机对照试验
贵州医科大学 高鸿教授课题组
翻译：张中伟 编辑：佟睿 审校：曹莹
一些研究证明了输注利多卡因和右美托咪定可减轻术后恶心和呕吐(PONV)的发生率。在此研究中，我们探讨了利多卡因和右美托咪定联合输注是否能降低全麻腹腔镜下子宫切除术后恶心呕吐的发生率。
将248例择期行腹腔镜子宫切除术的妇女分为以下四组:对照组(C组，n = 62)接受等量生理盐水，利多卡因组(L组，n = 62)接受静脉注射利多卡因(10分钟内推注1.5 mg/kg，1.5 mg/kg/h持续输注)，右美托咪定组(D组，n = 62)接受右美托咪定给药(10分钟内推注0.5 g/ kg，0.4 g/kg/h持续输注)， 利多卡因联合右美托咪定组(LD组，n = 62)接受利多卡因(10分钟内1.5 mg/kg的推注，1.5 mg/kg/h连续输注)和右美托咪定给药(10分钟内0.5 g/kg的推注，0.4 g/kg/h连续输注)的组合。主要结果是术后48小时内恶心、呕吐和PONV的发生率。次要结果包括术后24小时PONV总发生率、术中瑞芬太尼需要量、术后疼痛视觉模拟评分和芬太尼用量、麻醉后监护病房(PACU)停留期间心动过缓、躁动、寒战和口干的发生率。
术后0 ~ 2h内，LD组恶心和PONV的发生率(5.0%和8.3%)低于C组(21.7%和28.3%) (P < 0.05)。与C组(21.7%和28.3%)相比，L组(13.3%和20.0%)和D组(8.3%和13.3%)术后0-2h恶心和PONV的发生率无统计学差异。术后2–24小时和24–48小时，所有四组的恶心、呕吐和PONV发生率无统计学意义。LD组24 h总PONV发生率(33.3%)明显低于C组(60.0%) (P < 0.05)。与其他三组相比，LD组术后6小时和12小时芬太尼的总消耗量显著减少(P < 0.05)。LD组术后2、6、12 h的疼痛VAS评分明显低于其他三组(P < 0.05)。LD组和D组的术中瑞芬太尼用量明显低于C组和L组(P < 0.05)。与C组(分别为1.7、1.7和3.3%)和L组(分别为3.3、5.0和6.7%)相比，LD组在PACU停留期间口干、心动过缓和过度镇静的次数显著增加(分别为28.3、30.0和35.0%)(P < 0.05)。
利多卡因联合右美托咪定输注显著减少了0-2h恶心和PONV的发生率以及24 h PONV总发生率。但是，这种方法显著增加了全麻腹腔镜子宫切除术后PACU停留期间口干、心动过缓和过度镇静的发生率。
Siqi Xu, Shengbin Wang, Shenghong Hu，et al. Effects of lidocaine, dexmedetomidine, and their combination infusion on postoperative nausea and vomiting following laparoscopic hysterectomy: a randomized controlled trial.[J]. BMC Anesthesiol (2021) 21:199.
Effects of lidocaine, dexmedetomidine, and their combination infusion on postoperative nausea and vomiting following laparoscopic hysterectomy: a randomized controlled trial
Background: A few studies have reported that administration of lidocaine and dexmedetomidine relieves the incidence of postoperative nausea and vomiting (PONV). We explored whether combined infusion of lidocaine plus dexmedetomidine had lower occurrence of PONV undergoing laparoscopic hysterectomy with general anesthesia.
Methods: A total of 248 women undergoing elective laparoscopic hysterectomy were allocated into the following four groups: the control group (group C, n = 62) received an equal volume of saline, the lidocaine group (group L, n = 62) received intravenous lidocaine (bolus infusion of 1.5 mg/kg over 10 min, 1.5 mg/kg/h continuous infusion), the dexmedetomidine group (group D, n = 62) received dexmedetomidine administration (bolus infusion of 0.5 µg/kg over 10 min, 0.4 µg/kg/h continuous infusion), and the lidocaine plus dexmedetomidine group (group LD, n = 62) received combination of lidocaine (bolus infusion of 1.5 mg/kg over 10 min, 1.5 mg/kg/h continuous infusion) and dexmedetomidine administration (bolus infusion of 0.5 µg/kg over 10 min, 0.4 µg/kg/h continuous infusion). The primary outcome was the incidence of nausea, vomiting, and PONV during the first 48 h after surgery. The secondary outcomes included the incidence of total 24 h PONV after surgery, intraoperative remifentanil requirement, postop-erative pain visual analogue scale (VAS) scores and fentanyl consumption, the incidence of bradycardia, agitation, shivering, and mouth dry during post-anesthesia care unit (PACU) stay period.
Results: The occurrence of nausea and PONV in group LD (5.0 and 8.3%) at 0–2 h after operation was lower than group C (21.7 and 28.3%) (P < 0.05). There was no statistically significant difference with respect to occurrence of nausea and PONV in groups L (13.3 and 20.0%) and D (8.3 and 13.3%) at 0–2 h after operation compared to group C (21.7 and 28.3%). The incidence of nausea, vomiting, and PONV at 2–24 and 24–48 h after surgery in all four groups was not statistically significant. The incidence of total 24 h PONV in group LD (33.3%) was significantly decreased compared to group C (60.0%) (P < 0.05). The cumulative consumption of fentanyl at 6 and 12 h after surgery was significantly reduced in group LD compared to other three groups (P < 0.05). The pain VAS scores were significantly decreased at 2, 6, and 12 h after operation in group LD compared to other three groups (P < 0.05). Remifentanil dose in the intraoperative period was significantly lower in groups LD and D compared with groups C and L (P < 0.05). The number of mouth dry, bradycardia, and over sedation during the PACU stay period was markedly increased in group LD (28.3, 30.0, and 35.0%, respectively) compared with groups C (1.7, 1.7, and 3.3%, respectively) and L (3.3, 5.0, and 6.7%, respectively) (P < 0.05).
Conclusions: Lidocaine combined with dexmedetomidine infusion markedly decreased the occurrence of nausea and PONV at 0–2 h as well as the total 24 h PONV. However, it significantly increased the incidence of mouth dry, bradycardia, and over sedation during the PACU stay period after laparoscopic hysterectomy with general anesthesia.