静脉注射利多卡因对丙泊酚麻醉下阿芬太尼抑制人流手术患者体动反应的半数有效剂量的影响

Effect of Intravenous Lidocaine on the Half Effective Dose of Alfentanil in Propofol Anesthesia to Suppress the Somatic Motor Response of Patients Undergoing Artificial Abortion Surgery

关键词:  阿芬太尼  半数有效剂量  体动反应  利多卡因  术后镇痛  丙泊酚

Key words:  alfentanil  half effective dose  motor response  lidocaine  postoperative analgesia  propofol

摘要:

目的 研究静脉注射利多卡因对丙泊酚麻醉下阿芬太尼抑制人流手术患者体动反应的半数有效剂量（ED₅₀）的影响。方法 择期人工流产手术患者，年龄18~40岁，美国麻醉医师协会分级I~II级。随机分成2组，利多卡因联合阿芬太尼组（LA组）与阿芬太尼组（A组）。LA组患者静脉注射利多卡因1.0 mg·kg^-1后，缓慢注射丙泊酚2.0 mg·kg^-1及阿芬太尼（初始剂量为15.5 μg·kg^-1），A组患者则静脉注射0.1 mL·kg^-1生理盐水后，再依次缓慢注射丙泊酚2.0 mg·kg^-1与阿芬太尼。待患者意识消失后，消毒铺巾，观察患者置入宫颈探条的体动反应。采用序贯法计算阿芬太尼的剂量，若在置入宫腔探条时，发生体动阳性反应，则下一例患者剂量增加20%，反之则剂量降低20%。直至出现 ≥ 6个阳性反应和阴性反应的交替点，结束试验。采用概率单位回归分析法计算阿芬太尼抑制人流患者体动反应的ED₅₀、95%有效剂量（ED₉₅）及其95%可信区间（CI），记录术中生命体征，静脉注射痛，术后10 min、术后30 min、出院时疼痛评分及不良反应等指标。结果 LA组ED₅₀为6.55 μg·kg^-1（95%CI，2.10~8.07 μg·kg^-1），A组ED₅₀为8.24 μg·kg^-1（95%CI，6.75~9.75 μg·kg^-1），2组阿芬太尼的ED₅₀有差异；与A组比较，LA组术后10 min、术后30 min、出院时疼痛评分更低，差异有统计学意义（P<0.000 1或P<0.05）；LA组静脉注射痛发生率下降（减少44.2%），差异有统计学意义（P<0.01）；2组呼吸抑制发生例数、清醒时间与恶心呕吐等比较差异无统计学意义。结论 静脉注射利多卡因可显著降低阿芬太尼用于人流手术的ED₅₀，减少静脉注射痛发生率，缓解术后短期急性疼痛。

Abstract:

OBJECTIVE To investigate the effect of intravenous lidocaine on the half effective dose(ED₅₀) of alfentanil under propofol anesthesia to suppress the somatic motor response in patients undergoing artificial abortion surgery. METHODS Patients preparing to receive artificial abortion surgery, aged 18-40 years, with American Society of Anesthesiologists classification I-II were selected. They were randomly divided into two groups, lidocaine combined with alfentanil group(group LA) and alfentanil group(group A). Patients in the group LA received intravenous lidocaine 1.0 mg·kg^-1 followed by slow injection of propofol 2.0 mg·kg^-1 and alfentanil(initial dose of 15.5 μg·kg^-1). In group A, patients were given 0.1 mL·kg^-1saline intravenously followed by slow injection of propofol 2.0 mg·kg^-1 and alfentanil sequentially, and after the patients lost consciousness, disinfected towels were spread and the patients were observed for somatic motor response to the placement of the cervical probe. The dose of alfentanil was calculated using the sequential method, and if a positive somatotropic reaction occurred at the time of placement of the uterine probe, the dose was increased by 20% in the next patient and decreased by 20% in the opposite case. The test was terminated when more than six alternating points of positive and negative reactions occurred. Probabilistic unit regression analysis was used to calculate the ED₅₀value, the 95% effective dose(ED₉₅) value and its 95% confidence interval(CI) for alfentanil suppression of somatic motor response in patients undergoing abortion. Intraoperative vital signs, intravenous pain, pain scores at 10 min after surgery, 30 min after surgery, and discharge were recorded. RESULTS The ED₅₀ value in group LA was 6.55 μg·kg^-1(95%CI, 2.10-8.07 μg·kg^-1). The ED₅₀ value in group A were 8.24 μg·kg^-1(95%CI, 6.75-9.75 μg·kg^-1). There was a difference in the ED₅₀value for alfentanil in the two groups. The group LA had statistically lower pain score at 10 min after surgery, 30 min after surgery, and discharge compared with group A, the difference was statistically significant(P<0.000 1 or P<0.05). In group LA, the incidence of intravenous excision decreased(decrease by 44.2%), and the difference was statistically significant(P<0.0l). There was no statistically significant difference in the number of cases of respiratory depression, awake time and nausea and vomiting between the two groups. CONCLUSION Intravenous lidocaine can significantly reduce the ED₅₀ value of alfentanil for abortion surgery, reduce the incidence of intravenous pain, and relieve short-term acute postoperative pain.