罗哌卡因不同给药部位对术后镇痛的效果  

Effect of postoperative analgesic of ropivacaine in different administration sites

作　　者：赵丽[1] 张雅敏[2] 刘晓龙[2] 刘子荣[2] ZHAO Li;ZHANG Ya-min;LIU Xiao-long;LIU Zi-rong(Department of General Surgery,Tianjin Third Central Hospital Branch,Tianjin 300250,China;Department of General Surgery,Tianjin First Central Hospital)

机构地区：[1]天津市第三中心医院分院普外科,天津300250 [2]天津市第一中心医院普外科

出　　处：《中国城乡企业卫生》2021年第6期16-19,共4页Chinese Journal of Urban and Rural Enterprise Hygiene

摘　　要：目的探讨罗哌卡因术中不同给药部位对日间腹腔镜胆囊切除患者术后的镇痛效果。方法选取2018年10月—2019年3月天津市第一中心医院肝胆外科收治的胆囊结石合并慢性胆囊炎患者100例,均在全麻下行日间腹腔镜胆囊切除术。所有患者按随机数字表法分为A、B、C和D组各25例,A组:脐部、剑突下、右肋缘下切口、胆囊床及肝脏膈面喷洒10 ml生理盐水;B组:脐部、剑突下、右肋缘下切口浸润10 ml 0.75%罗哌卡因,胆囊床及肝脏膈面喷洒10 ml生理盐水;C组:脐部、剑突下、右肋缘下切浸润10 ml生理盐水,胆囊床及肝脏膈面喷洒10 ml 0.75%罗哌卡因;D组:脐部、剑突下、右肋缘下切口、胆囊床及肝脏膈面喷洒10 ml 0.75%罗哌卡因。术后监测呼吸、血压、心率、血氧饱和度、血浆皮质醇、视觉模拟评分(VAS)、是否需要额外镇痛治疗及术后不良反应的发生率。结果与术前2 h比较,术后四组血浆皮质醇水平均升高,B、C、D组术后3、6 h血浆皮质醇升高水平均低于A组,术后16 h内D组血浆皮质醇升高水平低于B、C组,差异均有统计学意义(P<0.05)。术后120 min内B、C、D组VAS评分明显低于A组,D组VAS评分最低。结论罗哌卡因切口浸润加胆囊床及肝脏面喷洒,应用于日间腹腔镜下胆囊切除术具有良好的镇痛效果,安全性高,有利于患者早日康复。Objective To investigate the postoperative analgesic effect of ropivacaine in different administration sites on day surgery of laparoscopic cholecystectomy.Methods From October 2018 to March 2019,100 patients with cholecystolithiasis and chronic cholecystitis in Department of Hepatobiliary Surgery of Tianjin First Central Hospital were selected.All patients underwent day surgery of laparoscopic cholecystectomy under general anesthesia.All patients were randomly divided into A,B,C and D group,with 25 cases in each group according to random number table method.A group:10 ml normal saline was infiltrated around the incisions of umbilicus,subxiphoid and right subcostal margin,gallbladder bed and diaphragmatic surface of liver;B group:10 ml 0.75% ropivacaine was infiltrated around the incisions of umbilicus,subxiphoid and right subcostal margin and 10 ml normal saline was sprayed on the gallbladder bed and diaphragmatic surface of liver;C group:10 ml normal saline was infiltrated around the incisions of umbilicus,subxiphoid and right subcostal margin and 10 ml 0.75% ropivacaine was sprayed on the gallbladder bed and diaphragmatic surface of liver;D group:10 ml 0.75% ropivacaine was infiltrated around the incisions of umbilicus,subxiphoid and right subcostal margin,the gallbladder bed and diaphragmatic surface of liver.Respiratory,blood pressure,heart rate,oxygen saturation,plasma cortisol,visual analogue score(VAS),need for additional analgesic treatment and incidence of postoperative adverse reactions were monitored.Results Compared with 2 h before operation,th e plasma cortisol levels of four g roups were increased after operation.Th e plasma cortisol levels at 3 and 6 h after operation in B,C and D g roup were lower th an th ose in A g roup.Th e plasma cortisol levels in D g roup were lower th an th ose in B and C g roup,and th e differences were statistically sig nificant(P<0.05).Th e VAS scores of B,C and D g roup were sig nificantly lower th an th at of A g roup with in 120 min after operation.Th e VAS score of

关 键 词：日间手术 腹腔镜胆囊切除术 罗哌卡因 镇痛 

分 类 号：R6[医药卫生—外科学]