CAJ | 학술논문

目的：探讨经皮肾穿刺通道周围局部浸润罗哌卡因缓解经皮肾镜取石（ percutaneous nephrolithotomy，PCNL）术后疼痛的效果。方法对接受单通道PCNL治疗的上尿路结石患者60例，随机分为两组，观察组和对照组（各30例）。观察组于PCNL术中留置肾造瘘管后，于经皮肾穿刺通道周围注射0.5％罗哌卡因20 mL，对照组则于相同部位注射等渗盐水20 mL。比较两组患者术后1、3、6、12、24 h的疼痛评分（ VAS），术后哌替啶使用情况及并发症。结果与对照组相比，观察组患者术后24 h内各相应时点的平均VAS评分均明显降低（P＜0.05），哌替啶用量明显减少[（21．7±13．5）mg vs （39．8±29．4） mg，P＜0．05]，首次需要应用哌替啶的时间明显延长[（16．6±9．7） h vs （6．8±4．2） h，P＜0.01]，而恶心及呕吐的发生率明显减少（23．3％vs 40.0％，P＜0.05）。结论罗哌卡因经皮肾穿刺通道周围局部浸润可有效缓解PCNL术后的切口疼痛，减少术后镇痛药需要量和相应并发症。
목적：탐토경피신천자통도주위국부침윤라고잡인완해경피신경취석（ percutaneous nephrolithotomy，PCNL）술후동통적효과。방법대접수단통도PCNL치료적상뇨로결석환자60례，수궤분위량조，관찰조화대조조（각30례）。관찰조우PCNL술중류치신조루관후，우경피신천자통도주위주사0.5％라고잡인20 mL，대조조칙우상동부위주사등삼염수20 mL。비교량조환자술후1、3、6、12、24 h적동통평분（ VAS），술후고체정사용정황급병발증。결과여대조조상비，관찰조환자술후24 h내각상응시점적평균VAS평분균명현강저（P＜0.05），고체정용량명현감소[（21．7±13．5）mg vs （39．8±29．4） mg，P＜0．05]，수차수요응용고체정적시간명현연장[（16．6±9．7） h vs （6．8±4．2） h，P＜0.01]，이악심급구토적발생솔명현감소（23．3％vs 40.0％，P＜0.05）。결론라고잡인경피신천자통도주위국부침윤가유효완해PCNL술후적절구동통，감소술후진통약수요량화상응병발증。
Objective To explore the analgesic efficacy of peritubal local anesthetic infiltration of ropivacaine in alleviating postoperative pain in patients with percutaneous nephrolithotomy ( PCNL) .Methods A total of 60 patients with upper urinary calculi were included and randomized into the ropivacaine group and the control group ( both 30 cases) .The patients in the ropivacaine group received a 20 mL infiltration of 0.5%ropivacaine into the Peritubal sites after a nephrostomy tube was inserted during PCNL, while pa-tients in the control group received 20 mL infiltration of saline.After the operation, patients'visual analog scale ( VAS) pain scores at 1, 3, 6, 12 and 24 hours, the usage of pain relief drugs and complications in the two groups were recorded.Results Compared with the control group, significant lower VAS pain scores at 1, 3, 6, 12, and 24 hours postoperatively (P<0.05 for all), less mean a-mount of pethidine [(21.7 ±13.5)mg vs (39.8 ±29.4)mg,P<0.05], longer mean time for the first demand of pethidine [(16.6 ± 9.7) h vs (6.8 ±4.2) h,P<0.01], and a lower rate of nausea and/or emesia (23.3%vs 40.0%, P<0.05) were observed in the experiment group.Conclusion Peritubal local anesthetic infiltration of ropivacaine can effectively alleviate postoperative pain after PCNL, and can reduce the usage of postoperative pain-killer as well as the related complications.