摘要
目的:观察氟比洛芬酯联合不同浓度甲磺酸罗哌卡因戳口局部浸润的镇痛方法对腹腔镜胆囊切除术后镇痛的效果。方法:将80例行三孔型术式腹腔镜胆囊切除手术患者常规麻醉诱导、麻醉维持,术中给予舒芬太尼0.3μg/kg和瑞芬太尼0.1μg/(kg.min)进行镇痛,术毕随机分为Con组(即对照组,不用局部浸润和氟比洛芬酯,n=20)、F组(单纯应用氟比洛芬酯100 mg,n=20)、FR0.25组(氟比洛芬酯100 mg+0.25%罗哌卡因6 mL 3点局部浸润,n=20)和FR0.5组(氟比洛芬酯100 mg+0.50%罗哌卡因6 mL 3点局部浸润,n=20)。所有患者疼痛数字等级评分(numeric rating scale,NRS)大于4分,哌替定50 mg肌注补救镇痛。分别于术毕即时(T0 h)、术后2 h(T2 h)、术后6 h(T6 h)、术后12 h(T12 h)、术后24 h(T24 h)、术后48 h(T48 h)测定并记录双盲NRS、补救镇痛的例数、收缩压、心率、术中应用镇痛药总量、手术时间及不良反应。结果:4组患者在性别、年龄、体重、基础收缩压、心率、术中应用舒芬太尼总量、瑞芬太尼总量及手术时间的差异无统计学意义(P﹥0.05);在T6 h时点,F组(4.96±1.15)与Con组(5.98±1.46)的NRS的组间差异有统计学意义(P﹤0.05);在T2 h、T6 h、T12 h时点FR0.25组、FR0.5组的NRS分别为2.34±0.89、3.01±1.27、2.79±0.94和2.42±0.79、2.69±0.96、2.03±0.87,明显低于Con组相对应的3.42±1.23、5.98±1.46、4.53±0.92(P﹤0.05);在T12 h时点,FR0.5组的NRS(2.03±0.87)明显低于FR0.25组(2.79±0.94,P﹤0.05);FR0.25组(2例)和FR0.5组(0例)的补救镇痛例数明显好于F组(6例),3组均优于Con组的15例(P﹤0.05);在T2 h、T6 h时点,FR0.25组[(114.19±6.74)mmHg、(108.31±7.62)mmHg,1 mmHg=0.133 kPa]和FR0.5组[(115.26±8.95)mmHg、(111.25±9.12)mmHg]收缩压明显低于Con组[(137.11±8.71)mmHg、(125.16±8.92)mmHg];FR0.25组(69.14±5.92)beats/min、FR0.5组(70.16±5.25)beats/min在T6 h时点心率波动均小于Con组(81.24±6.64)bpm,P﹤0.05;未见明显不良反应。结论:氟比洛芬酯联合戳口甲磺酸罗哌卡因局部浸润对腹腔镜胆囊切除术后镇痛效果确切,较高浓度罗哌卡因(0.5%)局部浸润联合氟比洛芬酯比低浓度罗哌卡因(0.25%)组镇痛效果更优、镇痛时间延长。
Objective： To investigate the effects of postoperative analgesia after laparoscopic cholecystectomy using intravenous flurbiprofen combined with different concentrations of ropivacaine incision infiltration.Methods：Eighty patients who underwent traditional laparoscopic cholecystectomy received stan-dard general anesthesia.At the end of surgery,patients were randomly divided into four groups： group Con（control group： no analgesics was administered,n=20）;group F（flurbiprofen group： 100 mg of flurbiprofen was given intravenously with no incision infiltration,n=20）;group FR0.25（100 mg of flurbiprofen was given intravenously,combined with 0.25% ropivacaine incision infiltration,2 mL per incision,6 mL in total,n=20） and group FR0.5（100 mg of flurbiprofen was given intravenously,combined with 0.5% ropivacaine incision infiltration,2 mL per incision,6 mL in total,n=20）.The intensity of postoperative pain was evaluated using numeric rating scale（NRS） in a double-blinded manner.Intramuscularly 50 mg of meperidin was administered as rescue medication when NRS was above 4.The NRS and the associated side effects were observed and recorded at the end of 0,2,6,12,24,and 48 hours postoperatively（T0 h,T2 h,T6 h,T12 h,T24 h,and T48 h）.Results：There was no obvious difference among the four groups in respect of gender,age,body weight,baseline blood pressure,heart rate（HR）,and total doses of sufentanil and remifentanil during operation and surgical time（P﹥0.05）.There were significant differences among group FR0.25（2.34±0.89,3.01±1.27,2.79±0.94）,group FR0.5（2.42±0.79,2.69±0.96,2.03±0.87）and group Con（3.42±1.23,5.98±1.46,4.53±0.92）in NRS at T2 h,T6 h,and T12 h（P﹤0.05）.Systolic blood pressures（SBP） of patients in group FR0.25[（114.19±6.74） mmHg,（108.31±7.62） mmHg）and group FR0.5[（115.26±8.95） mmHg,（111.25±9.12） mmHg]were significantly lower than those of patients in group Con[（137.11±8.71） mmHg,（125.16±8.92） mmHg]at T2 h and T6 h（P﹤0.05）.Compared with group Con[（81.24±6.64） beats/min],heart rate（HR） was also lower in patients of group FR0.25[（69.14±5.92） beats/min]and group FR0.5[（70.16±5.25） beats/min]at T6 h（P﹤0.05）.There was no obvious adverse effect in all the four groups.Conclusion：Intravenous flurbiprofen combined with ropivacaine infiltration could significantly reduce postoperative pain after laparoscopic cholecystectomy,providing more stable hemodynamics.Compared with 0.25% ropivacaine,0.5% ropivacaine infiltration combined with intravenous flurbiprofen has better and longer analgesic effects
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2011年第5期753-756,共4页
Journal of Peking University:Health Sciences
关键词
氟比洛芬
胆囊切除术
腹腔镜
镇痛
罗哌卡因
Flurbiprofen
Cholecystectomy
laparoscopic
Analgesia
Ropivacaine
