腹腔镜胆囊切除病人多模式超前镇痛的临床研究  

Multi-model Preemptive Analgesia for Patients Undergoing Iaparoscopic Cholecystectomy

作　　者：马越涛[1] 莫一兰[1] 蔡秋萍[1] 

机构地区：[1]大连市中心医院麻醉科,辽宁大连116021

出　　处：《中外医疗》2012年第33期31-32,34,共3页China & Foreign Medical Treatment

摘　　要：目的观察术前静注帕瑞昔布(parecoxib)联合罗哌卡因切口及腹腔内灌注对LC病人术后镇痛的效果。方法选择择期行LC患者120例,随机分为四组:帕瑞昔布组(P组);罗哌卡因组(R);帕瑞昔布+罗哌卡因组(P+R组)和对照组(C组)。观察病人术后2、4、6、12、24 h疼痛程度(VAS评分),观察术后出现肩背痛和需额外镇痛病人的比例情况。结果与对照组比较,R+P组病人术后各时间点VAS评分均明显降低(P<0.01);R组病人术后2 h VAS评分较对照组明显降低(P<0.05);P组病人术后6、12、24 h VAS评分较对照组,差异有统计学意义(P<0.05)。此外,各组术后需要注射杜冷丁镇痛的病人比例存在明显差异。术后出现肩痛和后背痛的病人比例R+P组和R组明显降低(P<0.01)。结论术前静注帕瑞昔布联合切口和腹腔内灌注罗哌卡因用于LC病人的术后镇痛效果确切,明显减少术后阿片类药物的用量。Objective To investigate the effects of postoperative analgesia after laparoscopic cholecystectomy（LC）using preincisional intravenous parecoxib combined with ropivacaine peritrocal infusion and intraperitoneal spray before the end of surgery.Methods 120 patients undergoing LC were randomized into four groups： P group（parecoxib group）;R group（ropivacaine group）;P＋R group（parecoxib＋ropivicain group）and C group（contral group）.Pain was measured 2、4、6、12、24h postoperatively using visual analogue scale scores（VAS）in a double-blinded manner.Percentage of patients occurring shoulder pain and receiving meperidine were also recorded.Results Compared with C group,VAS of postoperative pain were significant lower at all time points in P＋R group（P 0.01）;at 2 h in R group（P0.05）and at 6、12、24h in P group（P0.05）.In shoulder pain,significant lower percentage of patients were observed in P＋R group and R group（P0.01）.Frequency to use meperidine were significant lower in P group、R group and P＋R group compared with C group.Conclusion Preoperative Intravenous parecoxib combined with 0.5% ropivacaine peritrocal and intraperitoneal infiltration could significantly reduce postoperative pain after laparoscopic cholecystectomy and decrease postoperative opioid consumption.

关 键 词：胆囊切除 腹腔镜 超前镇痛 帕瑞昔布 罗哌卡因 

分 类 号：R4[医药卫生—临床医学]