全腹壁整形术后经腹直肌前鞘鞘内置管连续泵注罗哌卡因镇痛的临床研究  

Continuous pump infusion of ropivacaine through anterior rectus sheath internal tube for analgesia after total abdominoplasty

作　　者：吴赛男 吕倩雯 顾云鹏 孙晶晶 齐越 刘珍君 马桂娥 金骥 Wu Sainan;Lyu Qianwen;Gu Yunpeng;Sun Jingjing;Qi Yue;Liu Zhenjun;Ma Guie;Jin Ji(Department of Lipoplastic Surgery,Plastic Surgery Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100144,China)

机构地区：[1]中国医学科学院北京协和医学院整形外科医院脂肪整形一科,北京100144

出　　处：《中华整形外科杂志》2022年第9期1022-1027,共6页Chinese Journal of Plastic Surgery

摘　　要：目的探讨全腹壁整形术后腹直肌前鞘鞘内置管连续泵注罗哌卡因镇痛的临床效果。方法回顾性分析2020年8月至2021年12月中国医学科学院整形外科医院收治的全腹壁整形手术的患者资料。根据术后不同的镇痛方式分为2组:对照组术后行经静脉患者自控镇痛(PCIA)给药,舒芬太尼100μg+生理盐水稀释至100 ml,泵注速度为2 ml/h,连续泵注48 h,锁定时间15 min,Bolus:0.5 ml;研究组术后行腹直肌鞘内下行置管,连续泵注0.2625%罗哌卡因生理盐水混合液100 ml,泵注速度为2 ml/h,连续泵注48 h,锁定时间15 min,Bolus:0.5 ml。研究组的置管方式:直视下于腹直肌前鞘内单侧放置导管,于脐平面以下2 cm做切口,导管进入该切口后,向下延长3 cm左右达弓状线以下,导管另一端从脐周穿出,连接镇痛泵。记录术后24 h、48 h的疼痛视觉模拟评分(VAS)和镇痛泵按压次数,术后恶心、躁动、呕吐等药物不良反应发生情况,以及术后1个月的患者满意度。正态分布计量资料以x±s表示,2组间比较采用t检验;计数资料以频数(%)表示,采用Fisher确切概率检验进行分析。结果共纳入56例患者,男9例,女47例,年龄27~53岁,美国麻醉医师协会(ASA)分级1~2级,身体质量指数(BMI)为26~33 kg/m^(2),腹直肌分离范围为3~7 cm。与对照组相比,研究组术后48 h的疼痛VAS评分降低[(3.9±1.5)分vs.(5.2±1.4)分,P<0.05],镇痛泵按压次数减少[(2.9±0.3)次vs.(3.9±0.4)次,P<0.05],恶心、呕吐等不良反应发生率减少(P<0.05)。研究组术后1个月的满意率明显高于对照组[100.0%(30/30)vs.42.3%(11/26),P<0.05]。结论经腹直肌前鞘鞘内置管连续泵注罗哌卡因可以有效减轻全腹壁整形术后腹壁的疼痛,减少术后镇痛药导致的不良反应,提高住院期间患者舒适度和术后1个月满意度。Objective To evaluate the effect of continuous pump ropivacaine in rectus sheath in the postoperative analgesia after abdominoplasty.Methods Patients with abdominoplasty who were admitted to the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences from August 2020 to December 2021 were retrospectively analyzed.They were divided into 2 groups:the control group received patient-controlled intravenous analgesia(PCIA)after the operation,sufentanil 100μg+normal saline diluted to 100 ml,the rate was 2 ml/h,lasted for 48 h,locking time 15 min,Bolus:0.5 ml;the study group underwent postoperative rectus abdominis intrathecal intubation and continuously infused 0.2625%ropivacaine saline mixture 100 ml,the rate was 2 ml/h,lasted for 48 h,the locking time is 15 min,Bolus:0.5 ml.The method of catheter placement in the study group:a catheter was placed unilaterally in the anterior sheath of the rectus abdominis under direct vision,and an incision was made 2 cm below the umbilical plane.The other end is pierced from the umbilicus and connected to the analgesic pump.The visual analogue scale(VAS)for pain and the number of analgesic pump boluses at 24 h and 48 h after operation,the occurrence of postoperative adverse drug reactions and the patient satisfaction at 1 month after operation were collected.The normally distributed measurement data were expressed as Mean±SD,and the comparison between the two groups was analyzed by t-test;the count data was expressed by the frequency(percentage),and the Fisher’s test was used for analysis.Results A total of 56 patients were included,including 9 males and 47 females,ranging in age from 27 to 53 years old,with ASA graded from 1 to 2,body mass index(BMI)ranged from 26 to 33 kg/m^(2).Their rectus abdominis separation ranged from 3 to 7 cm.Compared with the control group,the pain VAS score of the study group at 48 hours after the operation was lower(3.9±1.5 vs.5.2±1.4,P<0.05),and the number of analgesic boluses was reduced(2.9±0.3 vs.3.9±0.4,P<0.05),the incidence of ad

关 键 词：腹直肌鞘 罗哌卡因 腹壁整形术 置管 术后镇痛 镇痛泵 

分 类 号：R614[医药卫生—麻醉学]