Effect of intravenous infusion of magnesium sulfate or lidocaine during anesthesia on postoperative recovery quality in early stage in patients undergoing upper airway surgery
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摘要:目的
比较麻醉期间静脉注射硫酸镁与利多卡因对上气道手术患者术后早期恢复质量的影响。
方法选取择期行上气道手术患者135例作为研究对象，采用随机数表法分为对照组、硫酸镁组和利多卡因组，每组45例。麻醉期间，硫酸镁组静脉注射硫酸镁，利多卡因组静脉注射利多卡因，对照组静脉注射等体积生理盐水。观察并比较3组患者术前（T0）、术后24 h（T1）、术后48 h（T2）的40项恢复质量评分量表（QoR-40）评分和术中瑞芬太尼用量、拔管后视觉模拟评分法（VAS）评分、补救镇痛发生情况、术后恶心呕吐（PONV）发生情况。
结果T1、T2时点，硫酸镁组QoR-40总分和身体舒适度、疼痛维度评分高于对照组，利多卡因组QoR-40总分和身体舒适度、情绪状态、疼痛维度评分高于对照组，差异有统计学意义（P < 0.05）；T1时点，利多卡因组自理能力维度评分高于对照组，差异有统计学意义（P < 0.05）；利多卡因组T1、T2时点的QoR-40总分高于硫酸镁组，且T1时点的情绪状态维度评分、T2时点的身体舒适度维度评分高于硫酸镁组，差异有统计学意义（P < 0.05）。硫酸镁组、利多卡因组术中瑞芬太尼用量少于对照组，拔管后VAS评分和术后48 h内PONV发生率低于对照组，差异有统计学意义（P < 0.05）；利多卡因组术中瑞芬太尼用量少于硫酸镁组，差异有统计学意义（P < 0.05）；3组补救镇痛率比较，差异无统计学意义（P>0.05）。
结论麻醉期间静脉注射利多卡因改善上气道手术患者术后早期恢复质量的效果相较于硫酸镁更好。
Abstract:ObjectiveTo compare the effect of intravenous infusion of magnesium sulfate and lidocaine during anesthesia on postoperative recovery quality in early stage in patients undergoing upper airway surgery.
MethodsA total of 135 patients undergoing elective upper airway surgery were recruited as study objects. The patients were divided into control group, magnesium sulfate group and lidocaine group by random number table method, with 45 cases in each group. During anesthesia, the patients in the magnesium sulfate group were intravenously injected with magnesium sulfate, those in the lidocaine group with lidocaine, and those in the control group with equal volume of normal saline. Quality of Recovery-40 (QoR-40) scores of patients were recorded preoperatively (T0), 24 h postoperatively (T1), and 48 h postoperatively (T2) were observed and compared, intraoperative remifentanil dose, Visual Analogue Scale (VAS) score after extubation, occurrence of rescue analgesia and postoperative nausea as well as vomiting (PONV) were compared.
ResultsThe total scores of QoR-40 and the scores of physical comfort and pain at T1 and T2 were significantly higher in the magnesium sulfate group than the control group, the total score of QoR-40, scores of physical comfort, emotional state and pain in the lidocaine group were higher than those in the control group (P < 0.05). At T1, the score of self-care ability in the lidocaine group was higher than that in the control group(P < 0.05). The total QoR-40 scores at T1 and T2 in the lidocaine group were higher than that in the magnesium sulfate group, and the emotional state score at T1 and physical comfort dimension score at T2 were higher than those in the magnesium sulfate group (P < 0.05). The amount of remifentanil in the magnesium sulfate group and the lidocaine group during operation was less than that of the control group, and the VAS score after extubation and the incidence of PONV within 48 h after operation were lower than the control group (P < 0.05). The postoperative amount of remifentanil in the lidocaine group was less than that in the magnesium sulfate group (P < 0.05). There was no significant difference in the remedial analgesia rate among the three groups (P>0.05).
ConclusionIntravenous infusion of lidocaine during anesthesia has better efficacy than magnesium sulfate in improving recovery quality in early stage in patients undergoing upper airway surgery.
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表 1 3组患者一般资料比较(x±s)[n(%)]
指标 分类 对照组(n=45) 硫酸镁组(n=45) 利多卡因组(n=45) 年龄/岁 46.6±11.6 44.3±10.6 42.2±12.7 BMI/(kg/m2) 24.4±2.7 25.0±2.7 24.6±2.9 性别 男 21(46.7) 24(53.3) 22(48.9) 女 24(53.3) 21(46.7) 23(51.1) 手术类型 声带手术 9(20.0) 9(20.0) 9(20.0) 会厌手术 10(22.2) 10(22.2) 10(22.2) 鼻窦手术 8(17.8) 8(17.8) 8(17.8) 扁桃体手术 9(20.0) 9(20.0) 9(20.0) 鼾症手术 9(20.0) 9(20.0) 9(20.0) ASA分级 Ⅰ级 32(71.1) 30(66.7) 33(73.3) Ⅱ级 13(28.9) 15(33.3) 12(26.7) 手术时间/min 34.7±24.6 38.2±30.5 35.1±24.3 BMI: 体质量指数; ASA: 美国麻醉医师协会。 
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表 2 3组患者QoR-40评分比较(x±s)
分 维度 组别 n T0 T1 T2 总分 对照组 45 189.7±6.6 172.4±7.8 177.1±5.2 硫酸镁组 45 191.9±3.3 177.9±3.3* 182.9±1.9* 利多卡因组 45 190.4±6.4 180.5±3.2*# 186.8±2.9*# 身体舒适度 对照组 45 55.8±2.9 48.7±3.5 50.6±2.7 硫酸镁组 45 56.2±2.3 50.0±1.8* 51.9±1.4* 利多卡因组 45 56.2±3.7 50.4±1.5* 55.0±2.2*# 情绪状态 对照组 45 42.1±3.3 40.4±2.8 42.4±1.9 硫酸镁组 45 43.2±1.7 41.0±1.3 42.9±0.9 利多卡因组 45 42.4±3.3 42.6±0.9*# 43.4±1.3* 自理能力 对照组 45 24.9±0.1 23.8±2.2 24.2±0.9 硫酸镁组 45 24.9±0.6 24.4±1.7 24.6±0.8 利多卡因组 45 24.9±0.2 24.4±0.7* 24.5±0.8 心理支持 对照组 45 34.8±1.0 33.3±1.8 33.3±1.4 硫酸镁组 45 34.9±0.3 33.8±1.1 33.8±0.7 利多卡因组 45 34.9±0.6 33.9±0.7 33.7±1.4 疼痛 对照组 45 31.9±2.4 26.2±3.4 26.5±3.4 硫酸镁组 45 32.6±1.8 28.6±1.5* 29.7±1.1* 利多卡因组 45 31.9±1.9 29.2±1.0* 30.2±1.3* QoR-40: 40项恢复质量评分量表。与对照组比较, *P < 0.05; 与硫酸镁组比较, #P < 0.05。
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表 3 组患者围术期指标水平比较(x±s)[n(%)]
组别 n 术中瑞芬太尼用量/μg 拔管后VAS评分/分 补救镇痛 PONV 对照组 45 167.1±81.9 1.8±1.2 6(13.3) 12(26.7) 硫酸镁组 45 124.4±94.7* 1.2±1.2* 3(6.7) 5(11.1)* 利多卡因组 45 100.2±60.0*# 1.1±1.0* 2(4.4) 4(8.9)* VAS: 视觉模拟评分法; PONV: 术后恶心呕吐。与对照组比较, *P < 0.05; 与硫酸镁组比较, #P < 0.05。
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