摘要
目的探讨切口内浸润及胆囊床喷洒盐酸罗哌卡因对腹腔镜胆囊切除术患者术后镇痛效果和安全性。方法选择在全麻下行腹腔镜胆囊切除术患者160例,随机分为4组。A组:在作腹壁切口前切口预定点注入0.75%盐酸罗哌卡因2 mL;B组:手术结束前向胆囊床喷洒盐酸罗哌卡因10 mL;C组:联合应用A/B组的处理;D组:不做任何以上处理。各组在术后均持续监测患者血氧饱和度、呼吸、血压、心电图,记录术后2、6、12、24 h的VAS评分、Ramsay评分和术后额外镇痛药使用情况及副作用发生情况。观察术前30 min、术后180min静脉血皮质醇含量。结果A、B、C三组术后12 h的VAS评分低于D组(P<0.05);4组患者各时间点Ramsay评分差异无统计学意义(P>0.05);A、B、C三组额外镇痛药使用次数少于D组(P<0.05);4组患者副作用发生情况差异无统计学意义(P>0.05);A、B、C三组在术后180 min血液中皮质醇含量少于D组(P<0.05)。结论罗哌卡因对腹腔镜胆囊切除术患者具有很好的镇痛效果,联合切口处浸润和胆囊床表面喷洒罗哌卡因的效果更佳,具有较好的安全性。
Objective To evaluate the safety and efficiency in pain control after laparoscopic cholecystectomy using ropivacaine hydrochloride for intra incisional infiltration and cholecystic bed spray.Methods One hundred and sixty patients ready for selective laparoscopic cholecystectomy under general anesthesia were randomly divided into four groups.Group A: 0.75% roprivaciane hydrochloric 2 mL was given to each incision before abdominal incision was cut down;group B: 10 mL of roprivaciane hydrochloride was sprayed to cholecystic bed before perforation equipment was withdrawn out;group C: combined use of group A and group B;group D: the patients were not given any ropivacaine hydrochloride.All patients experienced general anesthesia with fentanyl-propofol and endotracheal intubation with mechanical ventilation.SPO2,RR,EKG and blood pressure were monitored continuously for 24 h after the operation.VAS score and Ramsay score were evaluated at 2,6,12,24 hours after the operation.The use of additional analgesic and the incidence of side reaction was observed.Two mL of venous was taken 30 minutes before surgery and 180 minutes after surgery to determine the concentration of plasma cortisol.Results The scores of VSA in group A,B,C were lower than that of group D at 12 h after surgery(P<0.05);there was no significant difference in Ramsay score between four groups(P>0.05);compared with patients in group D,the patients in group A,B,C received less additional analgesic(P<0.05);the side reaction in four groups had no statistical difference(P>0.05);the concentration of plasma cortisol in group A,B,C was much lower than that in group D in 180 minutes after the operation(P <0.05).Conclusion Ropivacaine has good analgesic effect for patients with laparoscopic cholecystectomy,injecting ropivacaine into the incision and cholecystic bed is more effective and safer.
出处
《肝胆胰外科杂志》
CAS
2010年第1期34-37,共4页
Journal of Hepatopancreatobiliary Surgery
关键词
罗哌卡因
胆囊切除术
腹腔镜
镇痛
副作用
ropivacaine
cholecystectomy,laparoscopic
analgesia
adverse reaction
