【摘要】 目的 探讨静脉输注利多卡因联合胸椎旁神经阻滞对胸腔镜手术患者术后早期恢复的影响。方法 选取2023年7—12月择期行胸腔镜手术患者，随机分为两组：利多卡因联合胸椎旁神经阻滞组（观察组）和胸椎旁神经阻滞组（对照组）。观察组麻醉诱导前10 min内静脉给予利多卡因1 mg/kg，后以每小时2 mg/kg持续泵注至手术结束；对照组接受相同体积和速度的生理盐水。麻醉诱导后，均行超声引导胸椎旁神经阻滞，术后自愿接受自控静脉镇痛（PCIA）。主要指标：术后24 h的15项恢复质量评估量表（QoR-15）评分；次要指标：术后6、12、24、48 h静息和运动时数字等级评定量表（NRS）评分，Ramsay镇静评分，术后24、48 h血中TNF-α、IL-1β、IL-6水平，麻醉诱导前（T₀）、诱导后1 min（T₁）、气管插管即刻（T₂）、切皮即刻（T₃）、气管插管拔除即刻（T₄）的血流动力学指标（MAP、HR）、苏醒时间、拔管时间、麻醉恢复室（PACU）停留时间，术后恶心呕吐（PONV）发生率，术后不良反应发生情况。结果 共纳入患者90例，观察组与对照组各45例。观察组术后24、48 h的QoR-15评分分别是（119.4±3.23）分和（137.20±3.05）分，较对照组（112.5±5.15）分和（129.00±3.74）分升高（P<0.05）；观察组苏醒时间、拔管时间、PACU停留时间分别为：（7.31±2.53）min、（8.87±2.89）min、（30.89±4.80）min，较对照组的（9.81±2.43）min、（10.95±4.06）min、（33.95±6.32）min缩短（P<0.05）；观察组术后24、48 h的运动NRS评分为（2.42±0.72）分、（2.20±0.73）分，较对照组的（2.79±0.60）分、（2.58±0.82）分降低（P<0.05）；术后24、48 h的TNF-α、IL-1β、IL-6均降低（P<0.01）;MAP在T₂、T₃、T₄较低（P<0.01）;HR在T₁、T₂、T₃及T₄较低（P<0.05）；术后48 h内PONV发生率观察组（6.7%）明显低于对照组（23.2%）（P<0.05）。结论 胸腔镜手术患者围术期静脉输注利多卡因联合胸椎旁神经阻滞可获得更稳定术中血流动力学状态，提高术后QoR-15评分，降低PONV发生率，改善术后早期恢复质量。更多还原

【Abstract】 Objective To investigate the effect of intravenous lidocaine combined with thoracic paravertebral nerve block（TPVB） on early postoperative recovery in patients undergoing thoracoscopic surgery. Methods Patients scheduled for elective thoracoscopic surgery from July to December 2023 were selected and randomly divided into two groups: the lidocaine combined with TPVB group（intervention） and the TPVB-only group（control）. The intervention group received intravenous lidocaine（1 mg/kg bolus over 10 minutes before anesthesia induction, followed by continuous infusion at 2 mg/kg/h until surgery completion）, while the control group received equivalent volumes of normal saline at identical infusion rates. After anesthesia induction, both groups underwent ultrasound-guided TPVB and received postoeprative patient-controlled intravenous analgesia（PCIA）. Primary outcome: 24-hour postoperative Quality of Recovery-15（QoR-15） score; Secondary outcomes: Numerical Rating Scale（NRS） scores at rest and during movement（6,12,24,and 48 hours postoperatively）; Ramsay sedation scores; serum levels of TNF-α, IL-1β, and IL-6 at 24 and 48 hours postoperatively; mean arterial pressure（MAP） and heart rate（HR） at pre-induction（T₀）,1 minute post-induction（T₁）, immediately after tracheal intubation（T₂）, immediately after skin incision（T₃）,and immediately after tracheal extubation（T4）; Recovery time, extubation time, PACU stay duration; incidence of postoperative nausea and vomiting（PONV）; and postoperative adverse events. Results A total of 90 patients were included, with 45 cases in each group. Compared with the control group, the intervention group showed significantly higher QoR-15 scores at both 24 h（119. 4±3. 23 vs 112. 5±5. 15） and 48 h postoperatively（137. 20±3. 05 vs 129. 00±3. 74, P<0. 05）. The intervention group also showed shorter recovery time（7. 31±2. 53 vs 9. 81±2. 43） min, extubation time（8. 87±2. 89 vs 10. 95±4. 06） min and PACU stay duration（30. 89±4. 80 vs 33. 95±6. 32 min, all P<0. 05）.Additionally, the intervention group had lower movement NRS scores at 24 h（2. 42±0. 72 vs 2. 79±0. 60） and 48 h（2. 20±0. 73 vs 2. 58±0. 82, P<0. 05）, reduced TNF-α levels at both time point（P<0. 05）, and significantly decreased IL-1β and IL-6levels（P<0. 01）. The intervention group maintained lower MAP at T₂, T₃ and T4（P<0. 01） and lower HR at T₁, T₂, T₃, T4（P<0. 05）. The incidence of PONV within 48 h was significantly lower in the intervention group（6. 7% vs 23. 2%, P<0. 05）.Conclusion Perioperative intravenous infusion of lidocaine combined with TPVB in patients undergoing thoracoscopic surgery provides more stable intraoperative hemodynamics, improves postoperative QoR-15 score, reduces the incidence of PONV, and enhances the quality of early postoperative recovery.更多还原