术前使用罗哌卡因对腹腔镜胆囊切除术后镇痛效应的临床研究  

The clinical study of postoperative analgesic effect of preoperative ropivacaine injection in laparoscopic cholecystectomy

作　　者：陈明亮[1] 何振飞[1] 喻强[1] 朱晟[1] 张京平[1] 

机构地区：[1]南京医科大学附属常州市第二人民医院,江苏常州213003

出　　处：《腹腔镜外科杂志》2013年第2期152-154,共3页Journal of Laparoscopic Surgery

基　　金：常州市应用基础研究项目(编号:CJ20112018)

摘　　要：目的:观察腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)术前应用罗哌卡因切口浸润结合术中腹腔喷洒对术后疼痛的缓解效应。方法:随机将择期行LC的90例患者分为3组(n=30),A组术前用0.75%罗哌卡因13.3 ml(100 mg)逐层浸润切口并喷洒腹腔;B组术后使用静脉镇痛泵;C组为对照组,使用生理盐水,方法同A组。分别于麻醉苏醒后2 h、6 h、12 h、24 h记录镇痛模拟评分(visual analogue scale,VAS),并记录3组患者使用镇痛药情况。结果:3组患者术后均无并发症发生及相应毒副反应。术后2 h、6 h、12 h,A、B两组患者VAS评分差异无统计学意义(P>0.05),均明显低于C组(P<0.05)。A、B两组各有2例(6.7%)患者应用非甾体类抗炎药,C组11例(36.7%)应用非甾体类抗炎药,差异有统计学意义(P<0.05)。结论:术前罗哌卡因切口浸润结合腹腔内喷洒可明显降低LC术后早期VAS评分,具有良好的镇痛效果,可减少其他镇痛药物的使用量。Objective：To evaluate analgesic effect of ropivacaine infiltration in Trocar incision combined with intraperitoneal spray mitigation before the laparoscopic cholecystectomy （LC）. Methods：Ninety patients were randomly divided into 3 groups （n = 30） ,in group A 0.75% ropivacaine 13.3 ml （ 100 mg） was injected for incision infiltration layer by layer and sprayed in peritoneum, in group B controlled intravenous analgesia was used, in group C the sterile physiological saline was used as group A. In 2,6,12,24 hours after recovery from anesthesia, the pain intensity was recorded with the use of a visual analogue scale （VAS）, and the amounts of analgesics were recorded as well. Results：There were no complications and toxicity in each group, the VAS scores and the amounts of analgesics in group A and B were statistically significantly less compared with what in group C within 12 hours after surgery （P 〈 0.05 ）, especially within 6 hours. There were no statistically significant differences between groups A and B neither in VAS scores nor the dosages of analgesics （P 〉 0.05 ）. Non-steroid anti-inflammatory drug was used in 2 patients of group A and group B （6.7%）, and 11 patients of group C （36.7%） ,the difference was significant （P 〈 0.05 ）. Conclusions： Ropivacaine infiltration in Trocar incision combined with intraperitoneal spray mitigation before the LC can obviously reduce postoperative pain and the amount of other analgesic drugs, its analgesic effect is favorable.

关 键 词：胆囊切除术 腹腔镜 罗哌卡因 浸润麻醉 疼痛 手术后 

分 类 号：R657.4[医药卫生—外科学]