单孔腹腔镜阑尾切除联合切口注射罗哌卡因的临床效果观察

发布时间：2018-07-15 22:32

【摘要】：目的:研究分析单孔腹腔镜阑尾切除术联合切口注射罗哌卡因术后镇痛效果。方法:收集我科室2012年6月到2013年12月收治的急性阑尾炎、慢性阑尾炎患者为观察样本,总计78例。根据数字随机原理,利用Excel“Rand()”公式实现随机分为观察组(39例)和实验组(39例)。全部观察样本经术前全面的病史询问、详细体格检查、完善必要的辅助检查,明确诊断,排除手术禁忌证,除外合并其他系统疾病,全部实施单孔腹腔镜阑尾切除手术,实验组患者在脐部切口局部实施注射罗哌卡因溶液局部浸润麻醉(全麻成功,术区皮肤消毒铺单完毕,手术开始切皮前在患者脐部多点注射0.25%盐酸罗哌卡因溶液10ml,手术结束缝合切口前依次自切口深部向浅层再次注射0.25%盐酸罗哌卡因溶液10ml),对照组患者实施常规单孔腹腔镜阑尾切除术。手术后分别通过观察两组患者手术前后心率(HR)的变化,对患者的应用止痛药物的时间与剂量,术后排气时间、卧床时间、术后住院时间等。发生术后切口感染等不良反应的概率等指标进行观察,综合分析做出评价,比较两者之间有无差别。结果:实施切口局部注射罗哌卡因溶液的实验组患者术后疼痛指数均明显低于对照组,术后恢复时间明显缩短,且差异具有统计学意义(P0.01)。结论:单孔腹腔镜阑尾切除手术并切口局部注射罗哌卡因可以减少患者术后局部疼痛,不良反应发生的概率低,安全性好,患者舒适度、满意率高,不良反应小,是一种经济有效的术后镇痛方法,值得进一步推广。
[Abstract]:Objective: to study the analgesic effect of single-hole laparoscopic appendectomy combined with incision injection of ropivacaine. Methods: 78 patients with chronic appendicitis were collected from June 2012 to December 2013. According to the principle of digital randomness, Excel "Rand ()" formula was used to divide randomly into observation group (39 cases) and experimental group (39 cases). All the observation samples were examined by comprehensive medical history before operation, detailed physical examination, improvement of necessary auxiliary examination, definite diagnosis, exclusion of contraindications, except for other systemic diseases, and all patients underwent laparoscopic appendectomy. The patients in the experimental group were given local infiltration anesthesia with ropivacaine solution injected into the umbilical cord incision. Before skin incision, 0.25% ropivacaine hydrochloride solution was injected into the umbilical cord of the patient 10 ml, and 0.25% ropivacaine hydrochloride solution 10ml was injected again from deep to superficial layer before the incision was sutured. The patients in the control group were given routine single hole. Laparoscopic appendectomy. After operation, the changes of heart rate (HR) before and after operation, the time and dosage of painkillers, the time of exhaust, the time of bed rest and the time of hospitalization were observed. The probability of postoperative wound infection and other adverse reactions were observed, comprehensive analysis and evaluation were made to compare the difference between the two. Results: the postoperative pain index and recovery time of the patients in the experimental group were significantly lower than those in the control group, and the difference was statistically significant (P0.01). Conclusion: single hole laparoscopic appendectomy and local injection of ropivacaine through incision can reduce postoperative local pain, have low incidence of adverse reactions, good safety, comfort, high satisfaction rate and less adverse reaction. It is an economical and effective method for postoperative analgesia, which is worth further popularizing.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R656.8

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