摘要
目的:探讨罗哌卡因用于腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)中切口及腹膜内局部浸润、术区表面麻醉的术后镇痛效果。方法:选择全麻下行LC的60例患者,随机、双盲分为4组。A组:不进行任何处理;B组:手术结束前分别于脐部、剑突下、右肋缘下切口注入0.75%盐酸罗哌卡因2 ml;C组:手术结束前分别于脐部、剑突下、右肋缘下切口下周围腹膜注入0.75%盐酸罗哌卡因2 ml;D组:手术结束前分别在脐部、剑突下、右肋缘下皮肤切口及周围腹膜联合胆囊床、肝膈面喷洒0.75%盐酸罗哌卡因2 ml。4组患者的麻醉诱导、维持方法相同,术后均持续监测呼吸、血压、心率、血氧饱和度,记录术后2 h、6 h、12 h、24 h的疼痛视觉模拟评分及术后恶心、呕吐不良反应的发生率。结果:B、C、D组术后2~12 h的疼痛评分低于A组(P<0.05),D组疼痛评分低于B、C两组(P<0.05);术后恶心、呕吐发生率四组差异无统计学意义(P>0.05)。结论:罗哌卡因用于LC具有良好的镇痛效果,同时联合切口、切口周围腹膜及胆囊床、肝膈面表面喷洒罗哌卡因效果更佳,具有良好的安全性。
Objective：To discuss the analgesic effect of ropivacaine infiltration anesthesia which used on the surgery incision,peritoneum and operation area for the patients receiving laparoscopic cholecystectomy.Methods：Sixty patients who received general anesthesia in laparoscopic cholecystectomy and were selected as double-blind experiment samples were randomly divided into four groups.Group A：patients with no ropivacaine infiltration anesthesia;Group B：before the end of surgery,2 ml 0.75% ropivacaine was injected into subcutaneous areas of navel,below the xiphoid process and below right costal margin respectively;Group C：before the end of surgery,2 ml 0.75% ropivacaine was injected into subcutaneous areas and surrounding peritoneum of navel,below the xiphoid process and below right costal margin respectively;Group D：before the end of surgery,2 ml 0.75% ropivacaine was injected into subcutaneous areas and surrounding peritoneum of navel,below the xiphoid process and below right costal margin respectively,in addition,2 ml 0.75% ropivacaine was sprayed onto gallbladder bed and hepatic diaphragmatic surface.Anesthesia induction and maintenance methods were the same in each group.Breathing,blood pressure,heart rate and blood saturation of postoperative patients were continuously monitored.Visual analogue scale（VAS） score at 2,6,12 and 24 hours postoperatively,as well as incidence of postoperative adverse reactions of nausea and vomiting were recorded.Results：The VAS score at 2,6 and 12 hours postoperatively were lower in groups B,C and D compared with group A（P〈0.05）.And the VAS score of group D was lower than groups B and C（P〈0.05）.There were no significant differences among four groups for postoperative nausea and vomiting（P〉0.05）.Conclusions：Ropivacaine infiltration anesthesia with good security improves postoperative analgesia in patients receiving laparoscopic cholecystectomy.Moreover,it will get better postoperative analgesia effect if using ropivacaine local anesthesia for incision,surrounding peritoneum of incision,gallbladder bed and hepatic diaphragmatic surface at the same time.
出处
《腹腔镜外科杂志》
2017年第6期440-443,共4页
Journal of Laparoscopic Surgery
基金
深圳市科技创新项目(编号:JCYJ20150403101028193)
关键词
罗哌卡因
胆囊切除术
腹腔镜
镇痛
Ropivacaine
Cholecystectomy
laparoscopic
Analgesia
