CAJ | 학술논문

目的评价胆囊三角区浸润麻醉对腹腔镜胆囊切除术患者术后镇痛效果的影响.方法择期行腹腔镜胆囊切除术患者140例,性别不限,年龄18～ 64岁,18 kg/m2≤BMI≤31 kg/m2,ASA分级Ⅰ或Ⅱ级.采用随机数字表法,将其分为2组(n=70):对照组(A组)和胆囊三角区浸润麻醉组(B组).B组于胆囊分离前在胆囊三角区注射1％罗哌卡因10 ml,A组给予等容量生理盐水.2组于手术结束前10 min连接PCIA泵,持续镇痛48 h,维持VAS评分＜4分,当VAS评分≥4分持续时间超过30 min时,静脉注射曲马多1.5 mg/kg.记录PCIA药液消耗量以及曲马多使用情况;记录穿刺相关胆囊三角区重要结构损伤和局麻药中毒、恶心和呕吐等不良反应的发生情况;记录术后排气时间.结果与A组比较,B组PCIA药液消耗量、曲马多使用率及其用量减少(P＜0.05),恶心、呕吐发生率、术后排气时间差异无统计学意义(P＞0.05).2组未发生穿刺相关胆囊三角区重要结构损伤;B组未发生局麻药中毒.结论胆囊三角区浸润麻醉可优化腹腔镜胆囊切除术患者术后镇痛的效果.
목적 평개담낭삼각구침윤마취대복강경담낭절제술환자술후진통효과적영향.방법 택기행복강경담낭절제술환자140례,성별불한,년령18～ 64세,18 kg/m2≤BMI≤31 kg/m2,ASA분급Ⅰ혹Ⅱ급.채용수궤수자표법,장기분위2조(n=70):대조조(A조)화담낭삼각구침윤마취조(B조).B조우담낭분리전재담낭삼각구주사1％라고잡인10 ml,A조급여등용량생리염수.2조우수술결속전10 min련접PCIA빙,지속진통48 h,유지VAS평분＜4분,당VAS평분≥4분지속시간초과30 min시,정맥주사곡마다1.5 mg/kg.기록PCIA약액소모량이급곡마다사용정황;기록천자상관담낭삼각구중요결구손상화국마약중독、악심화구토등불량반응적발생정황;기록술후배기시간.결과 여A조비교,B조PCIA약액소모량、곡마다사용솔급기용량감소(P＜0.05),악심、구토발생솔、술후배기시간차이무통계학의의(P＞0.05).2조미발생천자상관담낭삼각구중요결구손상;B조미발생국마약중독.결론 담낭삼각구침윤마취가우화복강경담낭절제술환자술후진통적효과.
Objective To evaluate the effect of infiltration anesthesia at Calot's triangle on postoperative analgesia in the patients undergoing laparoscopic cholecystectomy.Methods One hundred and forty patients,aged 18-64 yr,with 18 kg/m2 ≤ body mass index ≤ 31 kg/m2,of ASA physical status Ⅰ or Ⅱ,scheduled for elective laparoscopic cholecystectomy,were randomly divided into 2 groups (n =70 each):control group (group A) and infiltration anesthesia at Calot's triangle group (group B).In group B,1％ ropivacaine 10 ml was injected into Calot's triangle before dissection of the gallbladder,while the equal volume of normal saline was injected into Calot's triangle in group A.The patients in both groups received patient-controlled intravenous analgesia (PCIA) for 48 h starting from 10 min before the end of surgery.The VAS score was maintained below 4 during PCIA.When VAS score ≥ 4,lasting for more than 30 min,tramadol 1.5 mg/kg was injected intravenously.The consumption of physic liquor for PCIA,and requirement for tramadol were recorded.The incidence of puncture-related damage to Calot's triangle and local anesthetic intoxication and adverse effects such as nausea and vomiting within 48 h after surgery were also recorded.The first postoperative flatus time was recorded.Results Compared with group A,the consumption of physic liquor for PCIA,requirement for tramadol,and consumption of tramadol were significantly reduced,and no significant change was found in the incidence of nausea and vomiting and the first postoperative flatus time in group B.No puncture-related damage to Calot's triangle occurred in A and B groups.There was no local anesthetic intoxication in group B.Conclusion Infiltration anesthesia at Calot's triangle can optimize postoperative analgesia in the patients undergoing laparoscopic cholecystectomy.