CAJ | 학술논문

目的探讨帕瑞昔布钠超前镇痛联合罗哌卡因局部浸润用于腹腔镜胆囊切除术患者术后镇痛的效果.方法选取拟在全麻下行腹腔镜胆囊切除术的患者150例,年龄41 ～ 63岁,体重55～87 kg,ASA分级Ⅰ级或Ⅱ级,采用随机数字表法,将患者随机分为3组(n=50):帕瑞昔布钠+0.9％生理盐水组(A组)、帕瑞昔布钠+0.5％罗哌卡因组(B组)和帕瑞昔布钠+0.75％罗哌卡因组(C组).于麻醉诱导前30 min静脉注射帕瑞昔布钠40 mg.采用瑞芬太尼和异丙酚双通道靶控输注麻醉.于缝皮前即刻,A组给予生理盐水12 ml,B组和C组分别给予0.5％和0.75％罗哌卡因12 ml行切口周围、皮下、肌肉、腹膜4点浸润麻醉.术后维持VAS评分≤3分,当VAS评分＞3分时,肌肉注射哌替啶75 mg.于术毕、术后2、4、8、12、24h时记录Ramsay镇静评分,记录术后24h内不良反应(恶心呕吐、过敏、呼吸抑制等)的发生情况、哌替啶使用情况、疼痛部位(切口痛、上腹痛、右肩牵涉痛)、切口愈合情况.结果与A组相比,B组和C组Ramsay镇静评分、恶心和呕吐发生率、哌替啶使用率和总用量及切口痛发生率降低(P＜0.05或0.01);与B组相比,C组哌替啶使用率和总用量及切口痛发生率降低(P＜ 0.05或0.01),Ramsay镇静评分差异无统计学意义(P＞0.05);3组切口愈合情况、上腹痛和右肩部牵涉痛的发生率比较差异无统计学意义(P＞0.05).结论对于腹腔镜胆囊切除术患者,罗哌卡因局部浸润麻醉可优化帕瑞昔布钠超前镇痛的效果,且采用0.75％罗哌卡因时可产生良好的术后镇痛效果.
목적 탐토파서석포납초전진통연합라고잡인국부침윤용우복강경담낭절제술환자술후진통적효과.방법 선취의재전마하행복강경담낭절제술적환자150례,년령41 ～ 63세,체중55～87 kg,ASA분급Ⅰ급혹Ⅱ급,채용수궤수자표법,장환자수궤분위3조(n=50):파서석포납+0.9％생리염수조(A조)、파서석포납+0.5％라고잡인조(B조)화파서석포납+0.75％라고잡인조(C조).우마취유도전30 min정맥주사파서석포납40 mg.채용서분태니화이병분쌍통도파공수주마취.우봉피전즉각,A조급여생리염수12 ml,B조화C조분별급여0.5％화0.75％라고잡인12 ml행절구주위、피하、기육、복막4점침윤마취.술후유지VAS평분≤3분,당VAS평분＞3분시,기육주사고체정75 mg.우술필、술후2、4、8、12、24h시기록Ramsay진정평분,기록술후24h내불량반응(악심구토、과민、호흡억제등)적발생정황、고체정사용정황、동통부위(절구통、상복통、우견견섭통)、절구유합정황.결과 여A조상비,B조화C조Ramsay진정평분、악심화구토발생솔、고체정사용솔화총용량급절구통발생솔강저(P＜0.05혹0.01);여B조상비,C조고체정사용솔화총용량급절구통발생솔강저(P＜ 0.05혹0.01),Ramsay진정평분차이무통계학의의(P＞0.05);3조절구유합정황、상복통화우견부견섭통적발생솔비교차이무통계학의의(P＞0.05).결론 대우복강경담낭절제술환자,라고잡인국부침윤마취가우화파서석포납초전진통적효과,차채용0.75％라고잡인시가산생량호적술후진통효과.
Objective To investigate the efficacy of preemptive analgesia with parecoxib sodium combined with local infiltration anesthesia with ropivacaine for postoperative pain after laparoscopic cholecystectomy.Methods One hundred and fifty ASA Ⅰ or Ⅱ patients,aged 41-63 yr,weighing 55-87 kg,scheduled for laparoscopic cholecystectomy under the general anesthesia,were randomly divided into 3 groups (n=50 each): parecoxib sodium+0.9％ normal saline (group A),parecoxib sodium + 0.5％ ropivacaine (group B) and parecoxib sodium + 0.75 ％ ropivacaine (group C).Parecoxib sodium 40 mg was injected intravenously 30 min before induction of anesthesia.Anesthesia was induced and maintained with remifentanil and propofol given by TCI.Immediately before skin closure,0.9％ normal saline 12 ml was given in group A,and 0.5％ and 0.75％ ropivacaine 12 ml were injected for local infiltration anesthesia in groups B and C,respectively.VAS scores were maintained ≤ 3after operation.When VAS scores ＞ 3,pethidine 75 mg was injected intramuscularly.Ramsay sedation scores were recorded at the end of operation and 2,4,8,12 and 24 h after operation.The side effects (nausea and vomiting,allergy,respiratory depression,etc.),requirement for pethidine,algesic sites (incisional pain,upper abdominal pain,referred pain in right shoulder),and condition of the wound healing were all recorded within 24 h after opcration.Results Compared with group A,Ramsay sedation scores,the incidence of nausea and vomiting,the requirement for pethidine and total amount of pethidine,and the incidence of incisional pain were significantly decreased in groups B and C (P ＜ 0.05 or 0.01).Compared with group B,the requirement for pethidine and total amount of pethidine,and the incidence of incisional pain were significantly decreased in group C (P ＜ 0.05 or 0.01).There was no significant difference in Ramsay sedation scores between groups B and C (P ＞ 0.05).There was no significant difference in the condition of the wound healing,upper abdominal pain and referred pain in right shoulder between groups A,B and C (P ＞ 0.05).Conclusion For the patients scheduled for laparoscopic cholecystectomy,local infiltration anesthesia with ropivacaine can improve the efficacy of preemptive analgesia with parecoxib sodium,and it provides better postoperative analgesia when 0.75 ％ ropivacaine is used.