Rimbäck G, Cassuto J, Tollesson P O
Department of Anesthesiology, Central Hospital, Mölndal, Sweden.
Anesth Analg. 1990 Apr;70(4):414-9.
The effects of continuous intravenous infusion of lidocaine on postoperative paralytic ileus in cholecystectomized patients was investigated in this double-blind study. An infusion of lidocaine (3 mg/min, n = 15) or an infusion of an equal volume of saline (n = 15) was started 30 min before induction of anesthesia and continued for 24 h after surgery. Postoperative colonic motility was evaluated by radiopaque markers and serial abdominal radiographs. A record was kept of the first passage of gas and feces. Results showed significantly earlier return of propulsive motility in the colon of lidocaine-treated patients. Radiopaque markers in the lidocaine group were propelled significantly earlier from the cecum/ascending colon to the transverse colon (P less than 0.05) and appeared significantly earlier in the descending colon (P less than 0.05) and the rectosigmoid colon (P less than 0.05) than in saline-treated patients. Despite the fact that the mean time for postoperative defecation occurred 17 h earlier in lidocaine-treated patients, differences between the groups were not statistically significant--a fact due, perhaps, to great individual variations in defecation habits. The time to first passage of gas, a variable representative of changes in anorectal or colonic tone rather than propagative motility, also did not differ significantly between the groups. No adverse reactions to lidocaine were reported. The results suggest that continuous intravenous infusion of lidocaine during the first postoperative day shortens the duration of paralytic ileus in the colon after abdominal surgery. Suppression of inhibitory gastrointestinal reflexes by reduction of postoperative peritoneal irritation is suggested as the mechanism of action.
在这项双盲研究中，调查了连续静脉输注利多卡因对胆囊切除术后患者术后麻痹性肠梗阻的影响。在麻醉诱导前30分钟开始输注利多卡因（3毫克/分钟，n = 15）或等体积的生理盐水（n = 15），并在术后持续24小时。通过不透X线标志物和系列腹部X线片评估术后结肠动力。记录气体和粪便的首次排出情况。结果显示，利多卡因治疗组患者结肠推进性动力的恢复明显更早。利多卡因组的不透X线标志物从盲肠/升结肠推进到横结肠的时间明显更早（P < 0.05），在降结肠（P < 0.05）和直肠乙状结肠（P < 0.05）出现的时间也明显早于生理盐水治疗组患者。尽管利多卡因治疗组患者术后排便的平均时间提前了17小时，但两组之间的差异无统计学意义——这可能是由于排便习惯的个体差异很大。作为代表肛门直肠或结肠张力变化而非推进性动力变化的变量，两组患者首次排气时间也无显著差异。未报告对利多卡因的不良反应。结果表明，术后第一天连续静脉输注利多卡因可缩短腹部手术后结肠麻痹性肠梗阻的持续时间。其作用机制可能是通过减轻术后腹膜刺激来抑制胃肠道抑制性反射。
