腹腔及切口注入盐酸罗哌卡因对于减少腹腔镜胆囊切除术并发症及术后镇痛效果的研究  

The analgesic effect of injecting roprivaciane hydrochloride into abdominal cavity and incision and the decrease of complications caused by laparoscopic cholesaystectomy

作　　者：张国栓[1] 郑志敏[1] 雅健[1] 张玉斌[1] 王岩[1] 戴光耀[1] 谷建斌[1] 李振符[1] 李士文[1] 

机构地区：[1]河北省石家庄市第一医院肝胆外科,050011

出　　处：《河北医药》2004年第12期940-941,共2页Hebei Medical Journal

摘　　要：目的　探讨腹腔镜胆囊切除术前后腹腔及切口内注入盐酸罗哌卡因对减轻术中胆心反射、术后胃肠道反应及术后镇痛效果的可行性。方法　 2 64例患者随机分为A(对照组 )、B(试验组 )两组 ,试验组患者行胆囊切除术前先向胆囊表面喷 0 .75 %盐酸罗哌卡因 4ml,术毕 (拔出穿孔器之前 )再向胆囊床及肝膈间隙喷洒 10ml ,缝合腹壁切口前向每个切口局部注入相同药液 2ml。若为 4孔则均为 1.5ml ;对照组为空白对照。观察术中胆心反射发生情况 ,术后 0、2、6、12、2 4h行VSA评分 ,记录术后患者右上腹、右肩背疼痛及腹壁切口疼痛情况及术后恶心呕吐 (PONV)情况 ,并于术前 3 0min、术后 3h抽取静脉血 2ml ,测定血浆皮质醇浓度。结果　A、B两组在胆心反射、术后 12h内VSA评分、PONV及术后 3h血浆皮质醇浓度等方面差异均有显著性 ,试验组优于对照组。结论　腹腔镜胆囊切除术前后腹腔及切口注入盐酸罗哌卡因对防止术中胆心反射的发生及减轻术后疼痛、呕吐等并发症有良好效果 ,值得临床推广。Objective To investigate the feasibility of injecting roprivaciane hydrochloride into abdominal cavity and incision to decrease cholecyst-heart refexion,gastroentercle response and pain feeling during laparoscopic cholescystectomy.Methods 264 patients were randomly divided into group A and group B.The patients in group B were given 0.75% roprivaciane hydrochloride to surface of cholecyst before cholecystectomy,roprivaciane hydrochloride 10 ml was given to gallbladder bed and hypatic diaphragm interspace before perforation equipment were furgged out,2 ml to incision before abdominal incision was sutured (1.5 ml to four incision).The patients in group A were not given ropivaciance hydrochloride.The cholecyst-heart reflexion during operation and VSA scores on 0,2,6,12,24 hour after surgery were recorded.Beware of pain feeling in right upper abdomen,right shoulder abdominal incision and PONY of patients,vein blood 2 ml was taken 30 minures before surgery and 3 hours after surgery to determine the concentration of corticosteroid.Results There were significant differences in cholecyst-heart reflexion,VSA scores in 12 hours after surgery,RONY and concentration of corticosteroid in 3 hours after surgery between two groups.Conclusion Injecting ropivacaine hydrachloride into abdominal cavity and incision before and after laparoscopic cholesaystectomy has good effect on preventing cholecyst-heart reflexion,which can decrease pain and nause vomit after surgey.This method deserves to be put forward.

关 键 词：并发症 罗哌卡因 胆心反射 术后 术前 切口 腹腔镜胆囊切除术 结论 情况 效果 

分 类 号：R657.4[医药卫生—外科学] R614[医药卫生—临床医学]