利多卡因对腹腔镜胃癌根治术患者术后疲劳综合征的影响

doi:10.3969/j.issn.1006-5725.2025.09.015

Abstract

Abstract:

Objective To investigate the effect of intravenous lidocaine on postoperative fatigue syndrome （POFS） in patients undergoing laparoscopic resection for gastric carcinoma. Methods A total of 80 patients who underwent elective laparoscopic resection for gastric carcinoma at Xuzhou Central Hospital between September 2023 and June 2024 were enrolled. Inclusion criteria included age 18 ~ 75 years， ASA physical status classification Ⅰ~Ⅲ， body mass index （BMI） of 18.5 ~ 27.9 kg/m2， preoperative Christensen score ≤4， and estimated operation time ≤ 4 hours. Patients were randomly allocated into either the lidocaine group （Group L） or the saline group （Group C） using a random number table， with 40 patients in each group. Group L received an intravenous infusion of lidocaine at a dose of 1.5 mg·kg?1 over 15 minutes， initiated 30 minutes before anesthesia induction. If no adverse reactions occurred， lidocaine was maintained at a rate of 1.5 mg/（kg·h） throughout the surgery until its conclusion. Group C received an equivalent volume of normal saline administered in the same manner. The Christensen score and Visual Analogue Scale （VAS） scores were recorded on postoperative days 1， 3， 5， and 7， and the time-weighted average （TWA） of the Christensen score was calculated. Postoperative inflammatory markers were measured， and additional outcomes including extubation time， post-anesthesia care unit （PACU） stay duration， postoperative nausea and vomiting （PONV）， consumption of rescue analgesics， time to first flatus and defecation， and length of hospital stay were also documented. Results Compared with Group C， the TWA of the Christensen score in Group L decreased by 0.44 points （95% CI： 0.11 ~ 0.76； P < 0.05）. The VAS scores were significantly lower in Group L on postoperative days 1 and 3 （P < 0.05）. Levels of IL-6 and TNF-α at the end of surgery and 24 hours after surgery were also lower in Group L （P < 0.05）. The time to first flatus and defecation was significantly shorter in Group L （P < 0.05）. There were no significant differences between the two groups regarding extubation time， PACU stay duration， incidence of PONV， postoperative consumption of remedial analgesic drugs， or length of hospital stay （P > 0.05）. Conclusion Intravenous lidocaine may improve POFS in patients following laparoscopic resection for gastric carcinoma by attenuating inflammatory responses， alleviating pain， and facilitating gastrointestinal function recovery， while maintaining a favorable safety profile.

Key words: lidocaine, postoperative fatigue syndrome, laparoscopic resection of gastric carcinoma

CLC Number:

R614.2

Songhai GUO,Liwei WANG,Bin SUN,Chunyan ZHOU,Weihua LI,Conghai FAN. Effect of intravenous lidocaine on postoperative fatigue syndrome in patients after laparoscopic resection of gastric carcinoma[J]. The Journal of Practical Medicine, 2025, 41(9): 1373-1378.

Figures/Tables 6

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References 33

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指标	L组（n = 36）	C组（n = 36）	t/Z/χ²值	P值
性别/例			-0.045	0.808
男	22	23
女	14	13
年龄［M（IQR）］/岁	68（14）	64（19）	-1.049	0.294
BMI［M（IQR）］/（kg/m²）	22.13（1.50）	22.21（2.68）	-0.045	0.964
ASA分级/例			0.127	0.722
Ⅰ级	0	0
Ⅱ级	31	32
Ⅲ级	5	4
TNM分期/例			0.575	0.448
Ⅱ期	26	23
Ⅲ期	10	13

指标	L组（n = 36）	C组（n = 36）	t/Z/χ ² 值	P值
手术时间（x ± s）/min	182.36 ± 24.42	184.59 ± 24.94	0.382	0.704
术中丙泊酚用量（x ± s）/mg	1 201.67 ± 164.46	1 215.00 ± 164.64	0.344	0.732
术中瑞芬太尼用量（x ± s）/μg	2 413.06 ± 361.38	2 416.67 ± 348.03	0.043	0.966
术中苯磺顺阿曲库铵用量（x ± s）/mg	17.67 ± 3.73	19.00 ± 4.18	1.428	0.158
术前1 d VAS疼痛评分［M（IQR）］/分	0.6（1.0）	0.6（1.0）	-0.557	0.578
术前1 d Christensen疲劳评分［M（IQR）］/分	1.80（0.50）	1.80（0.60）	-0.606	0.545

组别	例数	Christensen疲劳评分
L组	36
术后1 d		6.87 ± 0.81^#
术后3 d		5.83 ± 0.65^?#
术后5 d		4.72 ± 0.81^?#
术后7 d		3.97 ± 0.60^?#
C组	36
术后1 d		7.38 ± 0.74
术后3 d		6.24 ± 0.80^?
术后5 d		5.14 ± 0.83^?
术后7 d		4.43 ± 0.63^?
整体分析（HF）系数		0.936
组间比较F值		7.82
组间比较P值		0.007
时间比较F值		1 025.93
时间比较P值		< 0.001
交互作用F值		0.31
交互作用P值		0.781

组别	例数	VAS疼痛评分
L组	36
术后1 d		6.24 ± 0.88^#
术后3 d		3.22 ± 0.61^?#
术后5 d		2.53 ± 0.51^?
术后7 d		1.83 ± 0.28^?
C组	36
术后1 d		7.26 ± 0.81
术后3 d		3.68 ± 0.60^?
术后5 d		2.74 ± 0.44^?
术后7 d		1.93 ± 0.40^?
整体分析（HF）系数		0.953
组间比较F值		19.78
组间比较P值		< 0.001
时间比较F值		1431.53
时间比较P值		< 0.001
交互作用F值		13.22
交互作用P值		0.001

项目	L组（n = 36）	C组（n = 36）	t值	P值
IL-6
麻醉诱导前10 min	17.21 ± 4.43	18.25 ± 6.64	0.784	0.436
术毕即刻	88.97 ± 7.60	100.85 ± 9.54	5.844	< 0.001
术后24 h	40.07 ± 4.25	47.84 ± 4.78	7.728	< 0.001
TNF-α
麻醉诱导前10 min	22.00 ± 5.89	21.91 ± 4.07	-0.076	0.940
术毕即刻	71.86 ± 10.19	83.93 ± 8.30	5.513	<0.001
术后24 h	40.78 ± 6.04	48.64 ± 6.98	5.112	<0.001

Effect of intravenous lidocaine on postoperative fatigue syndrome in patients after laparoscopic resection of gastric carcinoma

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指标	L组（n = 36）	C组（n = 36）	t/Z/χ ² 值	P值
拔管时间［M（IQR）］/min	15（5）	15（4）	-0.980	0.327
PACU停留时间［M（IQR）］/min	43（6）	43（5）	-0.261	0.794
术后首次排气时间（x ± s）/h	28.75 ± 4.14	30.67 ± 3.70	2.070	0.042
术后首次排便时间（x ± s）/h	50.36 ± 4.47	53.31 ± 6.08	2.342	0.022
术后恶心呕吐/［例（%）］	9（25.0）	10（27.8）	0.071	0.789
补救性镇痛药物消耗量（x ± s）/mg	58.33 ± 18.90	65.28 ± 23.36	1.387	0.168
术后住院时间（x ± s）/d	10.40 ± 0.96	10.54 ± 1.17	0.552	0.583

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