急性阑尾炎患者早期止痛的临床探讨

Early pain relief in patients with acute appendicitis

目的 探讨早期使用止痛剂（盐酸哌替啶）对急性阑尾炎患者腹痛症状缓解、体格检查、诊断准确性和治疗效果的影响.方法 对120例急性阑尾炎进行疼痛VAS评分和早期止痛意愿调查,94例实施手术,73例VAS 5级以上者分为实验组与对照组进行统计学分析.结果 94例急性阑尾炎VAS 4级腹痛为21例（22.34%）均无止痛意愿;5～7级中度疼痛者为47例（50.00%）,其中有16例（34.04%）要求紧急止痛处理;8级剧烈疼痛患者26例（27.66%）中有23例（88.46%）要求紧急止痛;73例腹痛VAS 5级以上紧急止痛意愿率为53.42%,39例有紧急止痛意愿患者予盐酸哌替啶1.5 mg/kg肌肉注射,30～45 min后再次评估,疼痛评分下降2～5级,平均3.10级,止痛效果良好.实验组和对照组二次腹痛评估差异有统计学意义（P＜0.05）;而二次体格检查的腹部压痛部位均无改变,部分病例腹部压痛程度有所改变但未影响诊断,平均住院时间、术后并发症、误诊率的比较差异均无统计学意义（P＞0.05）.结论 早期止痛可有效缓解急性阑尾炎患者的腹痛症状,对体格检查、诊断准确性和治疗效果无影响.

Objective To investigate the influence of early use of analgesia（pethidine） on the management of acute abdomen（ acute appendicitis）. Methods Visual analog scale（VAS） was used to evaluate pain in 120 patients treated in the emergency department of our hospital in 2008. A survey was conducted to find if they had a desire for early pain relief. There were 94 acute appendicitis patients confirmed with surgery ,and 73 of them had a VAS score of 5 or above. These 73 patients were divided into experimental and control groups, and a statistical analysis was performed for comparison between groups. Results 21 of 94 patients （22.34%） had a VAS score of 4 or below, and all of them had no desire for early pain relief. 47 patients （50.00%） with moderate pain had a VAS score of 5 to 7, and 16 of them （ 34.04% ） requested immediate pain relief. 26 patients （27.66%） with severe pain had a VAS score of 8 or above, and 23 of them（ 88.46% ） requested immediate pain relief. Of the 73 patients with a VAS score of 5 or above ,39 （53.42%） had a desire for early pain relief. These 39 patients were injected with pethidine（ 1.5 mg/kg）. 30 to 45 minutes after the intramuscular injection,the symptom of abdominal pain was re - evaluated and the score decreased by 2 to 5 with an average of 3. 10 ,which proved the efficacy of early pain relief. The results of the second abdominal pain evaluation were significantly different between the experimental and control groups （P 〈 0.05 ）. But the abdominal tenderness site in the second medical examination was unchanged. The degree of abdominal tenderness in some cases was changed, but this did not affect the diagnosis. The average length of hospital stay, postoperative complications, and misdiagnosis rates between the two groups were not significantly different in this study （ P 〉 0.05 ）. Conclusion Early pain relief can effectively alleviate the symptom of abdominal pain in acute appendicitis. It does not affect the results of physical examination, accuracy of diagnosis, and efficacy of treatment.