术中切口联合局部麻醉改善后腹腔镜活体供肾切取术后疼痛的研究  

Intraoperative incision combined with local anesthesia to improve postoperative pain after laparoscopic live donor nephrectomy

作　　者：朱一辰[1] 侯雨时 吕竟成 郭宇文[1] 王志鹏[1] 万磊[2] Zhu Yichen;Hou Yushi;Lyu Jingcheng;Guo Yuwen;Wang Zhipeng;Wan Lei(Department of Urology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Anesthesiology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院泌尿外科,100050 [2]首都医科大学附属北京友谊医院麻醉科,100050

出　　处：《国际外科学杂志》2021年第12期829-833,F0004,共6页International Journal of Surgery

摘　　要：目的评估术中切口联合局部麻醉在改善后腹腔镜活体供肾切取术后疼痛的效果。方法采用回顾性研究方法,选取2018年1月—2020年12月于首都医科大学附属北京友谊医院接受了手辅助后腹腔镜活体供肾切取术的28例供者作为研究组,术中缝合伤口前使用0.2%罗哌卡因20 mL+5 mg地塞米松在腹横肌筋膜层面及皮下阻滞进行浸润麻醉。另1∶1匹配了28例相同手术方式但术后采用按需全身阿片类药物镇痛的供者作为对照组。比较两组患者的人口学指标(年龄、性别、体重指数、供肾长径),术中情况(术中出血量、手术时间、热缺血时间),术后2、12、24、48 h疼痛视觉模拟评分(VAS),术后全身阿片类药物需求率,术后恢复排气时间,恢复下地活动时间,并发症发生率(术后出血、肺部感染、淋巴瘘、伤口感染、肠梗阻),术后住院时间等资料。计量资料以均数±标准差(Mean±SD)表示,组间比较采用独立样本t检验;计数资料组间比较采用χ^(2)检验或Fisher确切概率法。结果两组供者的人口学指标及术中情况等方面比较,差异均无统计学意义(P>0.05)。研究组供者术后2、12、24、48 h疼痛VAS均显著低于对照组[2 h:(1.6±1.0)分比(3.9±1.1)分;12 h:(1.9±0.7)分比(3.1±1.0)分;24 h:(1.6±0.5)分比(2.9±0.8)分;48 h:(1.2±0.5)分比(2.3±0.8)分;P<0.05],术后吗啡需求率也显著低于对照组(0比21.4%),术后下地活动时间显著早于对照组[(25.7±4.5)h比(30.6±6.6)h],差异均具有统计学意义(P<0.05)。淋巴瘘为主要术后并发症,研究组和对照组患者比较((14.3%比25.0%),差异无统计学意义(P>0.05)。结论术中切口腹横肌筋膜及皮下联合局部阻滞麻醉可以有效地减轻腹腔镜供肾切除术后疼痛,减少阿片类药物的使用,促进供者术后早期活动,并不会增加术后并发症发生率。Objective To evaluate the effect of intraoperative incision combined with local anesthesia in improving postoperative pain after retroperitoneal laparoscopic living donor nephrectomy.Methods Using retrospective research methods,28 donors who underwent hand-assisted retroperitoneal laparoscopic living donor nephrectomy at the Beijing Friendship Hospital,Capital Medical University from January 2018 to December 2020 were selected as the research group.Before the wound was sutured during the operation use 0.2%ropivacaine 20 mL+5 mg dexamethasone to block the transverse abdominis fascia and subcutaneously for infiltration anesthesia.The other 1∶1 matched 28 donors who had the same operation method but used on-demand systemic opioid analgesia after the operation as the control group.The demographic indicators(age,gender,body mass index,length of donor kidney),intraoperative conditions(intraoperative blood loss,operation time,warm ischemia time),2,12,24,and 48 hours pain visual analogue scales(VAS)after operation were compared between the two groups of patients,postoperative systemic opioid demand rate,postoperative exhaust time,time to return to the ground,complication rate(postoperative bleeding,lung infection,lymphatic fistula,wound infection,intestinal obstruction),postoperative length of hospitalization and other information.Measurement data were expressed as mean±standard deviation(Mean±SD),and independent sample t-test was used for comparison between groups;Chi-square test or Fisher exact probability method was used for comparison of count data between groups.Results The pain VAS of the donors in the research group were significantly lower than those in the control group at 2 h,12 h,24 h,and 48 h after surgery(2 h:1.6±1.0 vs 3.9±1.1;12 h:1.9±0.7 vs 3.1±1.0;24 h:1.6±0.5 vs 2.9±0.8;48 h:1.2±0.5 vs 2.3±0.8;P<0.05).The donors in the research group postoperative morphine requirement rate was also significantly lower than that of the control group(0 vs 21.4%),and the postoperative recovery time was signific

关 键 词：活体供者 肾切取术 麻醉 局部 疼痛 手术后 

分 类 号：R699.2[医药卫生—泌尿科学]