超声引导下神经阻滞技术对腹股沟疝修补术后慢性疼痛的治疗作用  

Ultrasound-guided nerve block technique on chronic pain after inguinal hernia repair

作　　者：张邓新[1] 王叶纯 宗剑[1] 杜军[2] 费伯健[2] Zhang Dengxin;Wang Yechun;Zong Jian;Du Jun;Fei Bojian(Department of Anesthesiology.,the Affiliated Hospital of Jiangnan University,Wuxi 214062,China;Department of General Surgery,the Affiliated Hospital of Jiangnan University,Wuxi 214062,China)

机构地区：[1]江南大学附属医院疼痛科,无锡214062 [2]江南大学附属医院普外科,无锡214062

出　　处：《中华实验外科杂志》2020年第7期1306-1308,共3页Chinese Journal of Experimental Surgery

基　　金：江苏省无锡市科技局面上项目(WX18IIAN014);江苏省无锡市卫健委科技成果与适宜技术推广项目(T201908)。

摘　　要：目的观察超声引导下神经阻滞技术对腹股沟疝修补术后慢性疼痛的治疗作用。方法选取2018年8月至2019年12月江南大学附属医院腹股沟疝修补术后神经病理性疼痛患者30例,随机分成超声引导下神经阻滞治疗组(N组)、口服药物治疗组(D组)、超声引导下神经阻滞+口服药物联合治疗组(ND组),每组10例。N组采用超声引导下髂腹下神经、髂腹股沟神经和/或生殖股神经阻滞治疗,每周1次,连续3次;口服药物治疗组为普瑞巴林75 mg,一天两次;N+D组采用神经阻滞+口服药物治疗,方法分别同N、D组;神经阻滞治疗药物浓度为0.15%罗哌卡因+0.1 g/L得宝松+0.01 g/L维生素B12;用量为5 ml/每支神经。3组患者均必要时加服氨酚曲马多37.5 mg。观察治疗前、治疗后3、10、17 d时疼痛视觉模拟评分(VAS)、匹兹堡睡眠质量指数评分(PSQIS)、加服氨酚曲马多总量。各组VAS、PSQIS和加服氨酚曲马多用量的结果用单因素方差分析,在两两比较时用SNK法。结果各组治疗后3、10、17 d时VAS、PSQIS评分逐渐降低,与治疗前比较差异有统计学意义(P<0.05)。在治疗后10 d和17 d时,N组(q=4.701、5.984)和ND组(q=6.242、8.472)的VAS评分明显降低、与D组比较差异有统计学意义(P<0.05);ND组的PSQIS评分明显降低,与D组(q=4.859、7.289)和N组(q=5.762、6.338)比较差异有统计学意义(P<0.01)。N组治疗后17 d时,加服氨酚曲马多总量较治疗后3 d(q=3.263)、10 d(q=2.995)明显减少,差异有统计学意义(P<0.05);ND组治疗后10 d(q=3.328),17 d(q=3.692)时加服氨酚曲马多总量较治疗后3 d时明显减少,差异有统计学意义(P<0.05);ND组与D组比较,ND组治疗后10 d(q=4.624)、17 d(q=7.349)时加服氨酚曲马多总量明显减少,差异有统计学意义(P<0.05)。结论3组均可减轻患者的疼痛,超声引导下神经阻滞优于口服药物;而超声引导下神经阻滞联合口服药物疼痛治疗效果最好,并可明显改善患者的睡眠质量Objective:To observe the effect of ultrasound-guided nerve block on chronic pain after inguinal hernia repair.Methods:Thirty patients with postoperative chronic pain were randomly divided into ultrasound-guided nerve block treatment group(N group),oral drug treatment group(D group)and ultrasound-guided nerve block oral drug+oral treatment group(ND group),10 cases in each group.The N group was treated with ultrasound-guided iloinguinal nerve and iliohypogastric nerve and/or reproductive femoral nerve block once a week for three consecutive times.The D group was given Pregabalin 75 mg,twice every day.The ND group was treated with nerve block and oral drug,and the procedures were the same as those of N and D groups.The drug doses for the nerve block were as follows:0.15%ropivacaine,0.1 g/L diprospan,and 0.01 g/L vitamin B12,5/ml per branch nerve.All of patients in three groups were given 37.5 mg of aminophenol-tramadol when necessary.Pain visual analogue score(VAS),Pittsburgh sleep quality index score(PSQIS)and the amount of aminophenol-tramadol were record before,and 3,10 and 17 days after treatment.Results:The scores of VAS and PSQIS decreased gradually at 3,10 and 17 day after treatment in each group,and there was significant difference(P<0.05).At 10th and 17th day after treatment,the VAS scores in N group(q=4.701,5.984)and ND group(q=6.242,8.472)were significantly reduced as compared with those in D group(P<0.05),while PSQIS scores in ND group was significantly lower(P<0.01)than those in D group(q=4.859,7.289)and N group(q=5.762,6.338).The total amount of Amphenol-trimado in N group at 17th day was significantly lower than that at 3rd day(q=3.263)and 10th day(q=2.995)after treatment(P<0.05).The total amounts in ND group at 10th day(q=3.328)and 17th day(q=3.692)were significantly reduced compared to those at 3rd day after treatment(P<0.05),which were also significantly reduced compared to those at 10th day(q=4.624)and 17th day(q=7.349)in D group(P<0.05).Conclusion:All three groups can reduce the pain of the patie

关 键 词：术后慢性疼痛 腹股沟疝修补术 神经病理痛 超声引导神经阻滞 

分 类 号：R656.21[医药卫生—外科学]