胆囊三角区浸润麻醉对腹腔镜胆囊切除术后镇痛效果的影响：随机-对照-双盲-临床研究  

Effect of infiltration anesthesia at Calot＇s triangle on postoperative analgesia in patients undergoing laparoscopic cholecystectomy： a randomized, controlled, double-blind, clinical trial

作　　者：张东[1] 彭丽桦[1] 金菊英[1] 税敏[1] 闵苏[1] 

机构地区：[1]重庆医科大学附属第一医院麻醉科,400016

出　　处：《中华麻醉学杂志》2015年第2期175-177,共3页Chinese Journal of Anesthesiology

基　　金：重庆市卫生局重点项目（2013-1-008）;卫生部国家临床重点专科建设项目经费资助（财社[2011]170号）;重庆市医学重点学科建设项目经费资助（渝卫科教[2007]2号）

摘　　要：目的 评价胆囊三角区浸润麻醉对腹腔镜胆囊切除术患者术后镇痛效果的影响.方法 择期行腹腔镜胆囊切除术患者140例,性别不限,年龄18～ 64岁,18 kg/m2≤BMI≤31 kg/m2,ASA分级Ⅰ或Ⅱ级.采用随机数字表法,将其分为2组（n=70）：对照组（A组）和胆囊三角区浸润麻醉组（B组）.B组于胆囊分离前在胆囊三角区注射1％罗哌卡因10 ml,A组给予等容量生理盐水.2组于手术结束前10 min连接PCIA泵,持续镇痛48 h,维持VAS评分＜4分,当VAS评分≥4分持续时间超过30 min时,静脉注射曲马多1.5 mg/kg.记录PCIA药液消耗量以及曲马多使用情况;记录穿刺相关胆囊三角区重要结构损伤和局麻药中毒、恶心和呕吐等不良反应的发生情况;记录术后排气时间.结果 与A组比较,B组PCIA药液消耗量、曲马多使用率及其用量减少（P＜0.05）,恶心、呕吐发生率、术后排气时间差异无统计学意义（P＞0.05）.2组未发生穿刺相关胆囊三角区重要结构损伤;B组未发生局麻药中毒.结论 胆囊三角区浸润麻醉可优化腹腔镜胆囊切除术患者术后镇痛的效果.Objective To evaluate the effect of infiltration anesthesia at Calot＇s triangle on postoperative analgesia in the patients undergoing laparoscopic cholecystectomy.Methods One hundred and forty patients,aged 18-64 yr,with 18 kg/m2 ≤ body mass index ≤ 31 kg/m2,of ASA physical status Ⅰ or Ⅱ,scheduled for elective laparoscopic cholecystectomy,were randomly divided into 2 groups （n =70 each）：control group （group A） and infiltration anesthesia at Calot＇s triangle group （group B）.In group B,1% ropivacaine 10 ml was injected into Calot＇s triangle before dissection of the gallbladder,while the equal volume of normal saline was injected into Calot＇s triangle in group A.The patients in both groups received patient-controlled intravenous analgesia （PCIA） for 48 h starting from 10 min before the end of surgery.The VAS score was maintained below 4 during PCIA.When VAS score ≥ 4,lasting for more than 30 min,tramadol 1.5 mg/kg was injected intravenously.The consumption of physic liquor for PCIA,and requirement for tramadol were recorded.The incidence of puncture-related damage to Calot＇s triangle and local anesthetic intoxication and adverse effects such as nausea and vomiting within 48 h after surgery were also recorded.The first postoperative flatus time was recorded.Results Compared with group A,the consumption of physic liquor for PCIA,requirement for tramadol,and consumption of tramadol were significantly reduced,and no significant change was found in the incidence of nausea and vomiting and the first postoperative flatus time in group B.No puncture-related damage to Calot＇s triangle occurred in A and B groups.There was no local anesthetic intoxication in group B.Conclusion Infiltration anesthesia at Calot＇s triangle can optimize postoperative analgesia in the patients undergoing laparoscopic cholecystectomy.

关 键 词：胆囊切除术 腹腔镜 疼痛 手术后 麻醉 局部 胆囊 

分 类 号：R657.4[医药卫生—外科学]