腹腔镜胆囊切除术后超前镇痛的临床研究

Preemptive Analgesia Effect after Laparoscopic Cholecystectormy:A clinical study

目的观察全麻下腹腔区域阻滞对腹腔镜胆囊切除术后镇痛的影响。方法选择60例ASAⅠ-Ⅱ级择期手术病人，随机分为两组，比较碱化后的布比卡因注射肝膈间隙、肝十二指肠韧带周围和胆囊床后，在各时项阻滞疼痛的强度，以及各时项疼痛的缓解率。结果实验组术后7个时期项疼痛的VAS明显低于对照组（P〈0．01），无1例使用镇痛剂，对照组70％的病人强烈要求使用镇痛剂，组间比较有非常显著性差异（P〈0．01），各时项疼痛缓解率对比有显著性差异（P〈0．05—0．005）。结论在胆囊切除后应用碱化布比卡因在腹腔相应的部位进行神经阻滞，减轻了术后内脏痛的高峰期，强化了麻醉的效能，延长了麻醉作用时间，有效的缓解了内脏创伤引起的疼痛，改善了术后镇痛的效果。

Objective To observe the postoperative analgesic effects of laparoscopic cholecystectomy patients undergoing abdominal cavity field block during general anesthesia. Methods 60 patients, ASA, selected for laparoscopic cholecystectorny, were randomly divided into two groups. We researched analgesic intension and the remission rate of pain in various time after injected alkalified bupivacaine into gaps between liver and diaphragm, fields around liver and duodenum and gallbladder bed in two groups. Results Visual analog scales （VAS） in 7 different periods of experimental group were significantly lower than that of controlled group （P 〈 0.01 ）. No patients demanded to use analgesics in experimental group, on the other hand, 70% patients of controlled group demanded intensely analgesics（P 〈0.01 ）. The remission rates in different periods were obviously different in two groups（P 〈0. 005 - 0.05 ）. Conclusion Abdominal cavity field block in patients undergoing laparoscopic cholecystectomy during general anesthesia could significantly relief cresttime of postoperative pain, intensify anesthetic effects, extend anesthetic time, relieve pain caused by internal organs wound, improve postoperative analgesic effects.