老年结直肠癌患者术后切口局部持续浸润镇痛与静脉自控镇痛应用的对比研究  

Comparison of continuous local anesthetic infiltration and self-controlled intravenous analgesia for senile patients receiving colorectal cancer surgery

作　　者：何建华[1] 张民皓 辜晓岚[1] 顾连兵[1] HE Jianhua;ZHANG Minhao;GU Xiaolan;GU Lianbing(Department of Anesthesiology,Jiangsu Cancer Hospital & JiangsuInstitute of Cancer Research & The Affiliated CancerHospital of Nanjing Medical University,Nanjing210009,China)

机构地区：[1]南京医科大学附属肿瘤医院(江苏省肿瘤医院,江苏省肿瘤防治研究所)麻醉科

出　　处：《中国肿瘤外科杂志》2019年第4期269-273,共5页Chinese Journal of Surgical Oncology

基　　金：江苏省六大人才高峰项目(2016,WSW-019)

摘　　要：目的比较老年结直肠癌患者手术后使用切口局部持续镇痛系统与使用静脉自控镇痛泵的镇痛效果及镇痛相关的不良反应情况。方法选择2017年3月至2018年8月南京医科大学附属肿瘤医院普外科老年结直肠癌开腹手术患者46例,按照随机数字表法分为成两组。静脉自控镇痛组(n=23):手术结束后常规配制使用静脉自控镇痛泵;切口镇痛组(n=23):手术关腹时切口皮下放置多孔给药导管,接镇痛泵持续输注罗哌卡因。术后随访并记录疼痛评分、患者恶心、呕吐发生情况、Ramsay评分、呼吸抑制发生率以及皮肤瘙痒情况;吗啡补救使用剂量、切口感染情况、切口愈合情况以及肠功能恢复时间。结果与静脉自控镇痛组相比,切口镇痛组术后6h及12h疼痛评分更低(P<0.05),且切口镇痛组术后恶心、呕吐发生率更低,吗啡补救使用剂量更少,术后肠功能恢复时间更短(P<0.05);两组患者Ramsay评分、呼吸抑制发生率、皮肤瘙痒情况、切口感染情况及切口愈合情况无差异。结论老年患者腹部手术后使用切口镇痛系统进行术后镇痛效果更好,且副作用较低,加速患者术后康复,值得推广使用。Objective To compare the postoperative analgesic effect and adverse reaction of continuous local anesthetic infiltration and self-controlled intravenous analgesia in senile patients who were treated with colorectal cancer surgery.Methods Forty-six senile patients receiving colorectal cancer surgery in the Affiliated Cancer Hospital of Nanjing Medical University from Mar.2017 to Aug.2018 were enrolled in this study who were randomly divided into incision analgesia group (received continuous local anesthetic infiltration in incision after surgery) and intravenous analgesia group (received self-controlled intravenous analgesia) equally.The scores of Visual Analogue Scale,nausea and vomiting,Ramsay scores, incidence of respiratory depression and skin pruritus between two groups were compared.The dosage of morphine, the recovery time of intestinal function and the rate of incision infection were collected as well.Results Compared with the intravenous analgesia group,the pain score of incision analgesia group was lower at 6h and12h after surgery( P < 0.05).Meanwhile,the rate of nausea and vomiting,remedial dose of morphine and the recovery time of intestinal function were lower in incision analgesia group patients( P < 0.05).There was no significant difference between the two groups in Ramsay score, incidence of respiratory depression,the rate of incision infection and skin pruritus.Conclusions Continuous local anesthetic infiltration in incision has better analgesia effect for senile patients who underwent colorectal cancer surgery with fewer adverse reaction which accelerates the postoperative rehabilitation of patients.

关 键 词：术后镇痛 持续切口浸润 静脉自控镇痛 罗哌卡因 

分 类 号：R614[医药卫生—麻醉学] R735.34[医药卫生—外科学]