摘要
为探讨多模式镇痛在肛周疾病围手术期的应用效果，将2015年1月至2016年5月上海市嘉定区中心医院收治的180例肛周疾病患者随机分为对照组、治疗1组和治疗2组。对照组在手术结束时于创面皮下点状或环状注射0．5％盐酸罗哌卡因10mL；治疗1组在手术结束时于创面皮下点状或环状注射亚甲蓝（1mL）与罗哌卡因（5mL）的混合液6mL，予太宁栓1枚纳肛，术后第2天静脉推注帕瑞昔布钠40mg；治疗2组在治疗1组镇痛措施的基础上，术前30min静脉推注帕瑞昔布钠40mg进行超前镇痛。采用视觉模拟评分法（VAS）评定3组患者术后2h、6h、12h、20h肛门疼痛程度，记录术后并发症发生情况，术后第7天以问卷调查的形式调查患者对镇痛的满意程度。结果显示，1）镇痛效果：术后2h、6h、12h、20h治疗2组患者肛门VAS评分均明显低于治疗1组和对照组，P〈0．05；治疗1组与对照组比较，术后2h患者肛门VAS评分无统计学意义，P〉0．05，但是术后6h、12h、20h治疗1组患者肛门VAS评分明显低于对照组，P〈0．05。2）术后并发症：治疗1组和治疗2组术后头晕、创口水肿发生率明显低于对照组，P〈0．05。3）患者对镇痛效果的满意度：对照组、治疗1组、治疗2组患者对镇痛效果的满意度依次增高，差异有统计学意义，P〈0．001。结果表明，多模式镇痛，尤其是联合超前镇痛的多模式镇痛，用于肛周疾病围手术期镇痛效果更好，且安全、不良反应少，患者满意度高。
To explore the application effect of multimodal analgesia at perioperative period of perianal dis- eases, 180 patients with perianal diseases admitted in Jiading district Central Hospital of Shanghai city from January 2015 to May 2016 were randomly divided into control group and treatment group 1 treatment group 2.In control group, 10 mL of 0.5% ropivacaine hydrochloride was injected （point-like or ring-like） subcutaneously on the wound surface at the end of the operation. In treatment group 1,6 mL mixed liquor （1 mL methylene blue and 5 mL ropivaeaine） was injected as the same way ,and one Taining suppository was putting into anus, and 40 mg of parecoxib sodium was injected intravenously on the second day after operation.In treatment group 2,based on treatment group 1,40 mg of parecoxib sodium was injected at the 30 minutes before operation for preemptive analgesia.The：Visual analogue scale （VAS） was used to evalu- ate the anal pain degree at 2 h, 6 h, 12 h and 20 h after operation of the three groups. The incidence of postoperative complications was recorded. On the 7th day after operation, the patients were investigated by questionnaire about the analgesic satisfaction degree. As result, 1） analgesic effect： the anal VAS score of treatment group 2 at 2 h, 6 h, 12 h and 20 h after operation was significantly lower than of treatment group 1 and control group at 2 h after operation （ P〈0.05）; but there was no significant difference be- tween treatment group 1 and control group （ P〈0.05）, but the anal VAS score of treatment group 1 was significantly lower than that of control group at 6 h, 12 h and 20 h after operation （ P〈0.05）.2） Postop erative complications： the incidence of dizziness and incisional edema in treatment group 1 and treatmentgroup 2 was significantly lower than that in control group （ P 〈0.05）.3） patients＂ satisfiction degree about the analgesic effect .- The satisfaction degree of analgesic effect was increased successively in control group, treatment group 1 and treatment group 2, there was statistical significance in difference（ P〈0.001）.The results show that multimodal analgesia, especially combined with preemptive analgesia, is more effective in perioperative analgesia of perianal diseases and safer, and has fewer adverse reaction; the patients＇ satis- faction is high.
出处
《中国肛肠病杂志》
2017年第2期33-36,共4页
Chinese Journal of Coloproctology
基金
上海市重点专科项目（ZK2015810）
关键词
肛周疾病
多模式镇痛
超前镇痛
围手术期
Perianal disease
Multimodal analgesia
Preemptive analgesia
Perioperative period
