多模式镇痛在肛肠病手术中的应用价值  

Applicable Value of Intraoperative Multi-modal Anaglesia for the, Patients with Anal Diseases

作　　者：马兴燕[1] 张维亮[1] 

机构地区：[1]山东中医药大学附属医院,山东济南250011

出　　处：《中国肛肠病杂志》2013年第2期39-41,共3页Chinese Journal of Coloproctology

摘　　要：为观察多模式镇痛在肛门病手术中的应用价值，将2011年2月至2012年8月拟于连续硬膜外一蛛网膜下腔联合麻醉下手术治疗的250例肛肠疾病患者随机分为A～E5组，每组50例。A组为对照组，术毕不进行任何镇痛处理；B组术毕于肛周3、6、9点注射亚甲蓝混合液；C组术前静脉滴注特耐40mg^D组术前静脉滴注特耐40rag，术毕进行舒芬太尼自控静脉镇痛（PCIA）；E组术前静脉滴注特耐40rag，术毕进行耐乐品自控硬膜外镇痛（PCEA）。对比观察5组患者术后6h、12h、24h、48h及首次换药时的疼痛程度及不良反应。结果显示，A组各时刻VAS评分均明显高于其他4组，B、c组各时刻VAS评分明显高于D、E组，P〈O．05；B、C组问各时刻VAS评分差异均无统计学意义，P〉O．05；D、E组间术后6h、12h、24h、48hVAS评分差异无统计学意义，P〉O．05，但术后首次换药时D组VAS评分明显高于E组，P〈O．05。B组有3例出现局部灼痛感；D组有2例出现恶心，1例出现呕吐；其余各组无不良反应。结果表明，肛肠病患者围手术期多模式镇痛的效果明显优于其他单一镇痛模式，并且特耐复合耐乐品PCEA对患者术后运动痛更具有优势。This study was to evaluate the applicable value of intraoperative multi-modal analgesia for the patients with anal diseases. The 250 patients to be subjected to surgery under associated epidural and sub- arachnoid cavity anesthesia（2011-02 to 2012-08） were randomly divided into five groups： A,B,C,D, E,50 cases for each;group A was control one which did not receive any analgesia management;group B received methylene blue mixed injection at 3,6,9 points of perianus after operation; group C was intravenously in- stilled with Tenai （parecoxih sodium） 40rag be{ore operation; group D was intravenously instilled with Tenai 40 mg before operation,afterward received patient-control intravenous analgesia （PCIA） with sufen- tanil when operation ended;group E was intravenously injected with Tenai 40rag, secondaryly, received pa- tient-control epidural analgesia （PCEA） with Nailepin（ropiracaine）. The pain degree and adverse reactions of above 5 group＇s patients at 6,12,24 and 48h after operation as well as the first dressing change were ob- served and compared. As results,at all time-points VAS rating of group A was all significantly higher than that of rest 4 groups,and,group t3 and C significantly higher than group D and E（ P d0.05）;but,between B and C there was no statistical differences（ P 〉0.05） ;between D and E at 6,12,24 and 48h after opera- tion there also was no statistical differences（ P 〉0.05）,while at the first dressing change VAS rating of group D significantly higher than group E（ P 〈0.05） ;Except that 3 cases of group B suffered from local thermalgia,2 cases had nausea and 1 case vomiting in group D, there was no adverse reactions in rest groups. Results show that multi modal analgesia is superior to other any mono-modal one, and compound Tenai and Nailepin in PCEA has better efficacy on postoperative motion pain.

关 键 词：多模式镇痛 肛门病 术后镇痛 

分 类 号：R619[医药卫生—外科学]