阴部神经阻滞联合自控静脉镇痛在盆底重建术后镇痛中的应用  

THE APPLICATION OF PUDENDAL NERVE BLOCK COMBINED WITH SELF-CONTROLLED INTRAVENOUS ANALGESIA FOR PAIN RELIEF AFTER PELVIC RECONSTRUCTIVE SURGERY

作　　者：王莹 严虹[1] 吴若岚 陈璟莉[1] 陈丽[2] 孟杰 刘成[4] WANG Ying;YAN Hong;WU Ruo-Lan;CHEN Jin-Li;CHEN Li;MENG Jie;LIU Cheng(Anesthesiology Department,The Central Hospital of Wuhan,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430060,China;Anesthesiology Department,Hubei Cancer Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430060,China;Anesthesiology Department,The Central Hospital of Xiaogan,Wuhan University of Science and Technology,Wuhan 430060,China;Department of Gynecology and Obstetrics,Renmin Hospital of Wuhan University,Xiaogan 430060,China)

机构地区：[1]华中科技大学同济医学院附属武汉中心医院麻醉科,武汉430060 [2]华中科技大学同济医学院附属湖北肿瘤医院麻醉科,武汉430060 [3]武汉科技大学附属孝感医院(孝感市中心医院)麻醉科,孝感432000 [4]武汉大学人民医院妇II科,武汉430060

出　　处：《中国疼痛医学杂志》2019年第12期913-918,共6页Chinese Journal of Pain Medicine

基　　金：国家自然科学基金(81701424);武汉市卫计委科研立项(WX16D36)

摘　　要：目的:探讨阴部神经阻滞联合自控静脉镇痛能否提升盆底重建术后镇痛效果。方法:将160例盆底重建术病人随机等分为对照组和实验组,每组80例。对照组给予自控静脉镇痛,实验组给予双侧阴部神经阻滞联合自控静脉镇痛。记录术后不同时间点视觉模拟评分法(visual analogue scale,VAS)、镇静评分(Ramsay)、舒适度评分(bruggrmann comfort scale,BCS)评分,术后补救镇痛次数及不良反应。结果:与对照组比较,实验组在术后6 h、12 h时VAS评分显著降低、BCS评分显著增高(P<0.05),术后各时间点Ramsay评分均无显著差异;实验组术后2~24 h内补救镇痛次数显著降低,术后12 h内镇痛满意率显著增高(P<0.05),术后48 h内恶心、呕吐发生率显著降低(P<0.05),而头晕、呼吸抑制、心动过缓发生率则无显著性差异。结论:阴部神经阻滞联合自控静脉镇痛可有效的提高盆底重建术后镇痛疗效,且不增加副反应发生率。Objective:To investigate the efficacy of pudendal nerve block(PNB)combined with self-controlled intravenous analgesia for pain relief after pelvic reconstructive surgery.Methods:After Ethical Committee approval and informed consent,160 female patients scheduled for pelvic reconstructive surgery were randomized into control group(n=80)and study group(n=80).The control group was given self-controlled intravenous analgesia(PCIA)postoperatively,and the study group was given bilateral PNB combined with PCIA.Evaluated parameters were VAS,Ramsay,and BCS scores,frequency of remedial analgesia,adverse reactions and patient satisfaction.Data were evaluated at each time point within 2-48 h after surgery completion.Results:Compared with the control group,the VAS scores were significantly decreased and the BCS scores were significantly increased at 6 h and 12 h after surgery(P<0.05).There was no significant difference in Ramsay scores at each time point postoperatively.The study group was found to have significantly decreased number of remedial analgesia within 2-24 h,significantly better patient satisfaction within 12 h,and significantly lower incidences of nausea and vomiting within 48 h after surgery(P<0.05),while there was no significant difference in incidence of dizziness,respiratory depression and bradycardia within 48 h postoperatively.Conclusion:The pudendal nerve block combined with self-controlled intravenous analgesia can effectively improve the analgesic effect after pelvic reconstructive surgery without increasing the incidence of side effects.

关 键 词：术后镇痛 阴部神经阻滞 自控静脉镇痛 盆底重建术 

分 类 号：R614[医药卫生—麻醉学]