腹腔镜胆囊切除术胆囊三角罗哌卡因镇痛的临床对照研究

发布时间：2018-03-07 02:00

本文选题：腹腔镜胆囊切除术　切入点：罗哌卡因　出处：《重庆医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的观察腹腔镜胆囊切除术（LC）患者胆囊三角内应用罗哌卡因的镇痛效果及它对血浆皮质醇、血糖水平的影响。方法将60例LC患者随机分成2组，每组30例。实验组于术中在胆囊三角区注射罗哌卡因做局部浸润麻醉，对照组以等量生理盐水做空白对照。记录术后2h、6h、12h、24、48h视觉模拟评分（VAS）、舒适度评分及Ramsay镇静评分；于术前，术后6h、24h、48h抽取静脉血测皮质醇、血糖的浓度。结果两组病例的基本情况无差异（P＞0.05）。实验组术后2h、6h、12h、24hVAS评分、镇静评分较对照组低（P＜0.05），舒适度评分较对照组高（P＜0.05）；术后48h实验组VAS评分与对照组比较无差异（P＞0.05），，但镇静评分仍较对照组低（P＜0.05），舒适度评分较对照组高（P＜0.05）。与术前值比，两组术后6h、24h皮质醇、血糖浓度均升高（P＜0.05），实验组术后第二天恢复到术前水平（P＞0.05），对照组仍高于术前（P＜0.05）。与对照组相比，术后6h、24h实验组皮质醇及血糖浓度较低，差异有统计学意义（P＜0.05）；术后48h两组无明显差异（P＞0.05）。结论于胆囊三角区注射罗哌卡因做局部浸润麻醉能减轻LC患者的术后疼痛，提高术后舒适度，并起到一定的镇静作用，同时减轻LC手术的应激反应，从而降低了LC术后患者血浆皮质醇及血糖浓度。
[Abstract]:Purpose. To observe the analgesic effect of ropivacaine in cholecystectomy (LC) patients and the effect of ropivacaine on plasma cortisol and blood glucose levels. Method. Sixty patients with LC were randomly divided into two groups, 30 cases in each group. Ropivacaine was injected into the triangle of the gallbladder during the operation in the experimental group for local infiltration anesthesia. The visual analogue score (VAS), comfort score and Ramsay sedation score were recorded at 2 h and 6 h, 12 h and 24 h after operation, and the blood cortisol and blood glucose concentration were measured at 6 h and 24 h after operation. Results. There was no difference in the basic condition between the two groups (P > 0.05). The sedation score was lower than that in the control group (P < 0.05), the comfort score was higher than that in the control group (P < 0.05), the VAS score in the experimental group was not different from that in the control group (P > 0.05), but the sedation score was still lower than that in the control group (P < 0.05), and the comfort score was higher than that in the control group (P < 0.05). The concentration of cortisol in both groups increased at 6 hours and 24 hours after operation (P < 0.05), and recovered to the preoperative level at the second day after operation in the experimental group (P > 0.05), while that in the control group was still higher than that in the pre-operation group (P < 0.05). Compared with the control group, the concentration of cortisol and blood glucose in the experimental group at 6 hours and 24 hours after operation was lower than that in the control group. The difference was statistically significant (P < 0.05), but there was no significant difference between the two groups 48 hours after operation (P > 0.05). Conclusion. Injection of ropivacaine into the triangle of the gallbladder can relieve the postoperative pain, improve the comfort and sedation of patients with LC, and alleviate the stress reaction of LC. Thus, the plasma cortisol and blood glucose levels were decreased after LC.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R657.4

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