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摘要：
目的 探讨术中静脉输注利多卡因对全膝关节置换术（total knee arthroplasty, TKA）后阿片类药物用量、术后疼痛、全身炎症反应及膝关节功能恢复的影响。 方法 选择行单侧TKA的患者42例，ASA分级Ⅰ、Ⅱ级，采用随机数字表法分为2组（每组21例）：利多卡因组（L组）和对照组（C组）。两组麻醉其他用药相同基础上，L组麻醉诱导时静脉注射利多卡因1.5 mg/kg，随后以1.5 mg·kg−1·h−1的速度输注至手术结束，C组按同样的方式给予等体积的生理盐水。手术结束后两组患者均行患者自控静脉镇痛（patient‑controlled intravenous analgesia, PCIA）。主要结局指标为术中瑞芬太尼用量，出PACU、术后6 h、术后24 h、术后48 h舒芬太尼用量。次要结局指标为出PACU、术后6 h、术后24 h、术后48 h时患者膝关节静息及运动VAS疼痛评分，术后6、24、48 h大腿根部VAS疼痛评分，入室时（T0）、止血带充气时（T1）、止血带充气后30 min（T2）、松止血带时（T3）、拔管后（T4）的MAP、心率，术后24 h静脉血中性粒细胞/淋巴细胞（neutrophil/lymphocyte, N/L）、血小板/淋巴细胞（platelet/lymphocyte, P/L）、C反应蛋白（C‑reactive protein, CRP）水平，术后6 d膝关节关节活动度（knee range of motion, ROM）。 结果 与C组比较，L组出PACU、术后6 h、术后24 h、术后48 h时舒芬太尼用量减少（P<0.05）；两组术中瑞芬太尼用量差异无统计学意义（P>0.05）。与C组比较，L组出PACU、术后6 h膝关节静息和运动VAS疼痛评分降低（P<0.05）。与C组比较，L组T4时MAP、心率降低（P<0.05）。两组术后6、24、48 h大腿根部VAS疼痛评分及术后24 h静脉血N/L、P/L、CRP水平比较，差异无统计学意义（P>0.05）。L组术后6 d 膝关节ROM大于C组（P<0.05）且ROM更早达到90°（P<0.05）。 结论 术中静脉输注利多卡因能减少TKA后舒芬太尼用量，减轻术后疼痛，增加术后6 d 膝关节ROM，且能使ROM更早达到90°。
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Abstract: Objective To investigate the effects of intraoperative intravenous infusion of lidocaine on opioid dosage, postoperative pain, systemic inflammatory response and recovery of knee function after knee replacement. Methods Forty‑two patients undergoing unilateral total knee arthroplasty (TKA) under general anesthesia combined, American Society of Anesthesiologists (ASA) Ⅰ or Ⅱ were selected. The patients were divided into two groups according to random number table method (21 cases in each group): the lidocaine group (group L) and the control group (group C). On the basis of the same other anesthetics in the two groups, lidocaine was injected intravenously at 1.5 mg/kg during anesthesia induction, followed by 1.5 mg·kg−1·h−1 until the end of surgery, group C was given an equal volume of normal saline in the same way. The patient was given a patient‑controlled intravenous analgesia (PCIA) after surgery. Main outcome indicators for intraoperative remifentanil dosage, sufentanil dosage at post anesthesia care unit (PACU), 6 h, 24 h, and 48 h after surgery. Secondary outcome indicators for the knee rest and movement Visual Analogue Scale (VAS) cores at PACU, 6 h, 24 h, and 48 h after surgery, VAS score of thigh root at 6, 24 h and 48 h after surgery; mean arterial pressure (MAP) and heart rate in the two groups at the time of entry (T0), when the tourniquet was inflated (T1), 30 min after the tourniquet was inflated (T2), when the tourniquet was loosened (T3), and after extubation (T4); venous blood was taken within 24 h after surgery to detect neutrophil/lymphocyte (N/L), platelet/lymphocyte (P/L), C‑reactive protein (CRP); and knee range of motion (ROM) 6 d after surgery. Results Compared with group C, the dosage of sufentanil in group L was significantly reduced in the PACU, 6 h, 24 h, and 48 h after surgery (P<0.05). The intraoperative remifentanil dosage has no statistically significant difference between the two groups(P>0.05). The knee rest and movement VAS scores of patients in the group L were significantly decreased at PACU and 6 h after surgery (P<0.05). Compared with the group C, MAP and heart rate in group L were significantly decreased at T4 (P<0.05). There was no significant difference in the levels of N/L, P/L and CRP in venous blood at 24 h after surgery and VAS score of thigh root at 6, 24 h and 48 h after surgery (P>0.05). The ROM of the group L was higher than that of the group C 6 d after surgery (P<0.05), and the ROM of group L reached 90° earlier (P<0.05). Conclusions Intraoperative intravenous infusion of lidocaine can reduce the amount of sufentanil after TKA and relieve postoperative pain. It can increase the ROM of the knee 6 d after surgery and make the ROM of the knee each 90° earlier.
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