预防性镇痛联合不同局部麻醉方法对妇科腹腔镜术后镇痛的影响  

Effects of preventive analgesia combined with different local anesthesia methods on postoperative analgesia after gynecological laparoscopy

作　　者：李岚 王岳峰 陈永权[2] LI Lan;WANG Yuefeng;CHEN Yongquan(Department of Anesthesiology,Maternal and Child Hospital of Wuhu,Wuhu 241000,China;Department of Anesthesiology,Yijishan Hospital,Wannan Medical College)

机构地区：[1]安徽省芜湖市妇幼保健院麻醉科,安徽芜湖241000 [2]皖南医学院弋矶山医院麻醉科

出　　处：《沈阳医学院学报》2020年第6期528-531,共4页Journal of Shenyang Medical College

摘　　要：目的:观察预防性镇痛联合不同局部麻醉方法在妇科腹腔镜术后镇痛中的效果。方法:选择2017年10月至2018年2月芜湖市妇幼保健院和皖南医学院第一附属医院在全麻下行妇科腹腔镜择期手术的患者82例为研究对象,ASA分级Ⅰ-Ⅱ级,随机分为观察组(腹横肌筋膜平面阻滞)46例和对照组(局部浸润)36例,在手术开始前15 min均静脉滴注氟比洛芬酯50 mg,手术结束缝皮前静脉滴注氟比洛芬酯50 mg,格拉司琼3 mg。手术结束后,观察组行超声引导下双侧腹横肌筋膜平面阻滞,每侧注入浓度为0.25%的盐酸罗哌卡因20 ml;对照组在创口周围用0.5%盐酸罗哌卡因20 ml行局部浸润麻醉。比较患者拔除喉罩后5 min(T1)、术后4 h(T2)、8 h(T3)、12 h(T4)、24 h(T5)这5个时点的动静态视觉模拟评分(VAS)、Bruggrmann舒适度评分(BCS)、Ramsay镇静评分及恶心呕吐等不良反应的发生情况。结果:与对照组比较,观察组在T2、T3时点的VAS静态评分显著降低(P<0.05),在T2时点的VAS动态评分显著降低(P<0.05),而在其余时点,2组VAS评分差异无统计学意义(P>0.05);2组所有时点的Ramsay镇静评分差异均无统计学意义(P>0.05);在T5时点,观察组BCS评分高于对照组(P<0.05),其余时点2组BCS评分差异均无统计学意义(P>0.05);2组恶心呕吐等不良反应发生情况差异无统计学意义(P>0.05)。结论:预防性镇痛联合两种局部麻醉方法均能满足患者对术后镇痛的需求,提高患者的舒适度和满意度;腹横肌筋膜平面阻滞对于术后早期的疼痛镇痛效果更佳。Objective:To investigate the effects of preventive analgesia combined with different local anesthetic methods on postoperative analgesia after gynecological laparoscopy.Methods:From Oct 2017 to Feb 2018,a total of 82 patients underwent elective gynecologic laparoscopic surgery under general anesthesia,ASA gradeⅠ-Ⅱ,were randomly divided into transversus abdominis plane block group(group T,n=46)and local infiltration group(group L,n=36).The two groups received intravenous infusion of flurbiprofen axetil 50 mg 15 min before operation,and received intravenous infusion of flurbiprofen axetil 50 mg and granisetron 3 mg before the end of the operation.At the end of the operation,group T underwent ultrasound-guided bilateral transversus abdominis plane block,and each side was injected with 0.25%ropivacaine hydrochloride 20 ml.In group L,local infiltration anesthesia with 0.5%ropivacaine hydrochloride 20 ml around the wound after surgery was performed.At 5 min after removal of laryngeal mask(T1),postoperative 4 h(T2),8 h(T3),12 h(T4)and 24 h(T5),dynamic and static visual analogue scale(VAS),Bruggrmann comfort score(BCS),Ramsay sedation score,and the incidence of adverse reactions such as nausea and vomiting were compared.Results:Compared with those of group L,the static VAS scores of group T at T2 and T3 and the dynamic VAS score at T2 significantly decreased(P<0.05),while there was no significant difference in VAS scores between the two groups at other time points(P>0.05).There was no significant difference in Ramsay sedation scores between the two groups at all time points(P>0.05).At T5,the BCS score of group T was higher than that of group L(P<0.05),and there was no significant difference between the two groups at other time points(P>0.05).There was no significant difference in the incidence of nausea and vomiting between the two groups(P>0.05).Conclusions:Preventive analgesia combined with different local anesthesia methods can meet the patient’s need for postoperative analgesia,improve the comfort and satisfact

关 键 词：预防性镇痛 腹横肌筋膜平面阻滞 妇科腹腔镜手术 术后镇痛 氟比洛芬酯 

分 类 号：R614[医药卫生—麻醉学]