罗哌卡因局部镇痛用于实施快速康复外科的妇科腹腔镜手术患者镇痛疗效研究  

Analgesic Effect of Ropivacaine Local Analgesia in Gynecological Laparoscopic Surgery Patients Undergoing Enhanced Recovery after Surgery

作　　者：张然 翟建军[1] 于飞 徐彩炎[1] 田秀兰[1] 侯坤 Zhang Ran;Zhai Jianjun;Yu Fei(Department of Obstetrics and Gynecology,Beijing Tongren Hospital of Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院妇产科,100730

出　　处：《医学研究杂志》2020年第8期137-141,共5页Journal of Medical Research

基　　金：北京市经济开发区“新创工程”领军人才项目(京开党[2016]2号)。

摘　　要：目的比较观察在实施ERAS妇科腹腔镜手术后不同镇痛方式的镇痛疗效,探索罗哌卡因切口局部镇痛的镇痛效果,期待为腹腔镜手术患者提供一种安全、高效的术后镇痛方式,减轻患者焦虑,促进患者康复。方法选择2019年2-12月首都医科大学附属北京同仁医院妇科收治并实施ERAS的腹腔镜手术患者60例,将患者随机分为A、B、C 3个组,即联合镇痛组(罗哌卡因联合自控式静脉镇痛泵)、罗哌卡因切口局部浸润镇痛组和静脉自控式镇痛泵组.每组各20例。所有患者均实施加速康复外科理念,评估患者术前、术后24h SAS焦虑评分及术后4、8、12、24、36h VAS疼痛评分。结果围术期焦虑情况比较:3组患者围术期焦虑评分比较.术前比较差异无统计学意义(P>0.05);术后比较差异有统计学意义(P<0.05)。术后3组间两两比较可见A、B组间比较差异无统计学意义(P>0.017),A、C组间与B、C组间,差异均有统计学意义(P<0.017),且C组患者评分中位数及平均秩均较A组及B组高。术后疼痛程度情况比较:3组患者术后不同时间点疼痛评分比较差异有统计学意义(P<0.05)。3组间两两比较可见术后4、8、24、36h,A组和B组疼痛评分比较,差异无统计学意义(P>0.017);A组与C组、B组与C组比较,差异有统计学意义(P<0.017),且C组疼痛评分中位数及平均秩均>A组和B组。结论罗哌卡因切口局部镇痛可有效缓解实施ERAS理念的妇科腹腔镜患者的术后疼痛,同时可减少患者围术期焦虑,是一种有效、方便可行的镇痛方法,值得在临床中推广。Objective By comparing and observing the analgesic effect of different analgesic methods in the implementation of gynecological laparoscopic surgery with ERAS conceptions,we want to explore the analgesic effect of ropivacaine used in local incision,in order to provide a safe and efficient way of analgesia for patients undergoing laparoscopic surgery,reducing anxiety in patients and promoting recovery as soon as possible.Methods There are 60 patients selected from Beijing Tongren Hospital of Capital Medical University who were treated by gynecological laparoscopic surgery with ERAS from February 2019 to December 2019.The patients were divided into groups A,B and C randomly,which represent the combining analgesia group(ropivacaine combined with controlled intravenous analgesia pump),ropivacaine incision local infiltration analgesia group and intravenous controlled analgesia pump group,with 20 patients in each group.The concept of ERAS was applied to all the patients.SAS anxiety scores were obtained 24 hours before and after the operation as well as VAS pain grade were obtained at 4,8,12,24,36h after the operation.Results Comparison of perioperative anxiety among the three groups showed no statistically significant preoperative difference(P>0.05)while the postoperative difference was statistically significant(P<0.05).Postoperative pairwise comparison among the three groups showed no statistical difference between group A and B(P>0.017),and there were statistical differences between group A and C and between group B and C(P<0.017),and the median score and average rank of patients in group C were higher than those in group A and group B.Comparison of postoperative pain degree among the three groups:there was a statistically significant difference in postoperative pain grade between the three groups at different time points(P<0.05).Pairwise comparison among the three groups after 4,8,24.36 hours shows that between group A and group B,there were no statistically significant difference(P>0.017).The differences between gr

关 键 词：罗哌卡因 快速康复外科 妇科腹腔镜手术 镇痛技术 

分 类 号：R7I3[医药卫生—临床医学] R971.2