预防性镇痛在肝胆管结石治疗中的临床应用  

Clinical application of preventive analgesia in the treatment of hepatolithiasis

作　　者：谭正[1] 龚金龙[1] 彭创[1] 周济民[1] 袁文加 TAN Zheng;GONG Jin-long;PENG Chuang;ZHOU Ji-min;YUAN Wen-jia(Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital, Changsha 410005, China)

机构地区：[1]湖南省人民医院肝胆外科,湖南长沙410005

出　　处：《肝胆胰外科杂志》2017年第4期301-304,共4页Journal of Hepatopancreatobiliary Surgery

基　　金：湖南省高层次卫生人才"225"工程项目(2013-13);湖南省卫生厅科研基金项目(B2011-075)

摘　　要：目的探索预防性镇痛在肝胆管结石治疗中的应用价值。方法将2015年1月至2016年10月湖南省人民医院肝胆外科收治的90例肝胆管结石患者随机分为观察组和对照组,每组各45例。观察组术后予静脉自控镇痛泵+术后连续3 d使用氟比洛芬酯静滴100 mg qd+术后3 d使用地佐辛注射液5 mg肌注qn。对照组仅予静脉自控镇痛泵处理,患者疼痛难忍时予肌注盐酸哌替啶。比较两组患者术后6、12、24、48、72h疼痛评分,术后首次下床活动时间,肛门排气时间、住院天数、住院费用及并发症。结果观察组术后6、12、24、48、72 h疼痛评分均低于对照组[(2.42±0.92)vs(3.16±0.71),(2.07±0.62)vs(2.44±0.76),(2.29±0.55)vs(2.82±0.61),(2.53±0.50)vs(2.77±0.52),(1.58±0.50)vs(2.44±0.59)],差异有统计学意义(P<0.05)。观察组首次下床活动时间、排气时间、住院天数均短于对照组[(1.49±0.51)d vs(2.36±0.48)d,(3.2±0.66)d vs(3.6±0.65)d,(8.09±0.90)d vs(8.96±1.04)d],差异有统计学意义(P<0.05)。两组患者住院费用[(5.5±1.5)万元vs(5.3±1.7)万元]及术后并发症发生率无统计学差异(P>0.05)]。结论肝胆管结石术后预防性镇痛方案安全有效,可以减少患者术后疼痛,加速患者康复。Objective To explore the value of preventive analgesia in the treatment of hepatolithiasis.MethodsA total of90patients with hepatolithiasis admitted in Hunan Provincial People’s Hospital between Jan.2015and Oct.2016were randomly into Observation group and Control group(each group50cases).The Observationgroup were treated with vein self-control analgesia pump and postoperative continuous flurbiprofen axetil100mgqd for3d,and postoperative with dezocine5mg intramuscular injection qn for3d.The Control group were onlyoffered with vein self-control analgesia pump treatment.The pain score at6,12,24,48and72h postoperative,time of first ambulation,time of recovery of the anal exsufflation and complications were compared betweentwo group.Results In the observation group,the pain score at6,12,24and48h postoperative were lower thanthose in the control group[(2.42±0.92)vs(3.16±0.71),(2.07±0.62)vs(2.44±0.76),(2.29±0.55)vs(2.82±0.61),(2.53±0.50)vs(2.77±0.52),(1.58±0.50)vs(2.44±0.59)],the difference was all statistically significant(P<0.05).The time of first ambulation[(1.49±0.51)d vs(2.36±0.48)d],the time of first exhaust[(3.2±0.66)d vs(3.6±0.65)d],duration of hospitalization[(8.09±0.90)d vs(8.96±1.04)d]in the observation group were all shorter thanthose in the control group,the difference were all statistically significant(P<0.05).There was no significant differenceon hospitalization cost[(55.0±15.0)thousand yuan vs(53.0±17.0)thousand yuan]and postoperativecomplications between two groups(P>0.05).Conclusion Preventive analgesia application in the treatment ofhepatolithiasis is safe and effective,which may reduce pain score and accelerate patients rehabilitation.

关 键 词：预防性镇痛 加速康复外科 肝胆管结石 

分 类 号：R657.42[医药卫生—外科学]