联合局部浸润麻醉在胃肠外科腹腔镜手术中的应用

发布时间：2018-03-05 06:45

本文选题：术后疼痛　切入点：术后镇痛　出处：《华中科技大学》2014年博士论文　论文类型：学位论文

【摘要】：目的：调查我院胃肠外科常规手术患者术后镇痛效果,观察局部浸润麻醉在胃肠外科腹腔镜手术中的辅助镇痛作用,探索新型镇痛模式。研究对象：2013年3月至2013年9月我院胃肠外科出院手术病人；以及2013年10月至2014年2月胃肠外科单组收治的年龄大于18岁的胃、结直肠肿瘤患者需限期术治疗者。方法：采用问卷的形式调查140例随机抽取的出院手术病人,分析统计患者住院期间疼痛与镇痛效果以及出院后疼痛和整体镇痛效果满意度；临床试验将52例入组病人随机分成实验组(30)和对照组(22),实验组在腹腔镜手术开始前,于手术部位腹膜外局部注射0.75%罗哌卡因(Ropivacaine)20ml,对照组不予相应处理,术后观察比较两组间疼痛程度(VAS)、生命体征变化、不良反应、下床、通气、术后并发症、术后住院时间及住院费用等。结果：问卷调查显示,出院手术病人(119例)约52.9%(63例)能够回忆起住院期间明显的疼痛不适,平均NRS疼痛评分为4.68±1.12分；约73.9%(88例)患者认为术后疼痛会影响自己早期下床,47.1%(56例)患者因为疼痛不愿咳嗽排痰；对住院期间镇痛效果平均评分3.27±0.81分(满分5分),其中有约47.9%(57例)评分在3分或以下。临床试验中,实验组与对照组相比,患者术后1h、3h、6h、18h、36h和48h活动状态下疼痛程度VAS评分明显降低,术后镇痛相关不良反应明显减少,术后下床时间明显提前；而对于术后PCA药物用量、术后慢性疼痛、术后并发症、术后住院时间及住院费用无明显影响。结论：目前胃肠外科的术后镇痛方法并不能很好的控制患者术后疼痛,还可能因此增加患者术后相关并发症。而腹腔镜手术前手术部位罗哌卡因腹膜外局部浸润麻醉,在一定程度上可以帮助改善患者术后疼痛状况,促进早期下床活动,同时缩短住院时间,减少病人住院费用。
[Abstract]:Objective: to investigate the effect of postoperative analgesia in patients undergoing routine gastrointestinal surgery in our hospital, to observe the auxiliary analgesic effect of local invasive anesthesia in laparoscopic operation of gastrointestinal surgery, and to explore a new mode of analgesia. Participants: patients with gastrointestinal surgery discharged from our hospital from March 2013 to September 2013, and patients with colorectal cancer who were treated in a single group of gastrointestinal surgery patients aged more than 18 years from October 2013 to October 2013. Methods: 140 randomly selected patients who were discharged from hospital were investigated by questionnaire, and the results of pain and analgesia during hospitalization, as well as the satisfaction of pain and overall analgesic effect after discharge were analyzed. 52 patients were randomly divided into experimental group (n = 30) and control group (n = 22). The experimental group was given 0.75% ropivacaine or ropivacaine20 ml at the site of operation before laparoscopy, and the control group was not treated accordingly. The degree of pain, vital signs, adverse reactions, getting out of bed, ventilation, postoperative complications, postoperative hospitalization time and hospitalization expenses were observed and compared between the two groups. Results: the questionnaire survey showed that there were 119 patients (52.9%) who were discharged from hospital. The average NRS pain score was 4.68 卤1.12. About 73.9% of 88 patients thought that postoperative pain would affect their early exit from bed 47.1% and 56 cases) patients were unwilling to cough and discharge phlegm because of pain; The average score of analgesic effect during hospitalization was 3.27 卤0.81 (with a full score of 5 and 57 cases). In the clinical trial, the VAS score of pain degree in the experimental group was significantly lower than that in the control group at 1 h, 3 h, 6 h, 18 h, 36 h and 48 h, respectively. Postoperative analgesia related adverse reactions were significantly reduced, and the time of getting out of bed was significantly earlier. However, there was no significant effect on postoperative PCA dosage, postoperative chronic pain, postoperative complications, postoperative hospital stay and hospitalization expenses. Conclusion: the current postoperative analgesia in gastrointestinal surgery can not control the postoperative pain, and may increase the postoperative complications. To some extent, it can help to improve the postoperative pain, promote the early activity of getting out of bed, at the same time shorten the hospitalization time and reduce the cost of hospitalization.
【学位授予单位】：华中科技大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R614

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