酮咯酸氨丁三醇用于腹腔镜胆囊切除术对患者超前镇痛的观察

Effects of preemptive ketorolac tromethamine on postoperative analgesia in patients undergoing laparoscopic cholecystectomy

目的观察酮咯酸氨丁三醇对于腹腔镜胆囊切除术(LC)患者的超前镇痛作用。方法 60例择期行LC患者随机分为T组、R组、C组3组,各20例。T组分别于切皮前30 min缓慢静脉推注酮咯酸氨丁三醇30 mg(0.9%氯化钠溶液稀释至10 ml),手术结束前30 min缓慢静脉推注0.9%氯化钠溶液10 ml;R组切皮前30 min缓慢静脉推注0.9%氯化钠溶液10 ml,手术结束前30 min缓慢静脉推注酮咯酸氨丁三醇30 mg;C组分别于切皮前30 min、手术结束前30 min缓慢静脉推注0.9%氯化钠溶液10 ml。采用视觉模拟量表(VAS)评价3组各时点的疼痛强度,采用Ramsay系统进行术后镇静评分,并观察术后的不良反应。结果在术后30 min、1 h、3 h、6 h,T组和R组的VAS均比C组的低,差异有统计学意义(P<0.05),在其余时点,两组VAS的差异无统计学意义。而T组和R组的VAS的差异无统计学意义(P>0.05),术后C组曲马多用量明显大于T组和R组(P<0.05)。结论酮咯酸氨丁三醇能效缓解腹腔镜手术的术后疼痛,且无明显不良反应,但在LC中超前镇痛的效果与给药时点无明显关系。

Objective To determine the efficacy and safety of preoperative ketorolac tromethamine on postoperative pain relief after laparoscopic cholecystectomy.Methods Sixty ASAⅠ～Ⅱ patients（20～45 year-old） who underwent elective laparoscopic cholecystectomy under general anesthesia were randomized to 3 groups.Group T received ketorolac tromethamine 30 mg 30 min before skin incision and received 10ml normal saline 30 min before operation finished.Group R received 10ml normal saline 30min before skin incision and received ketorolac tromethamine 30mg 30min before operation finished.Group C only received 10ml normal saline at that two time points.VAS scores at 30 min,1,3,6,9,12 h postoperatively were assessed.Results There was no significant difference between group T and group R in VAS scores（P 0.05）.The VAS of group T and R were lower than that of group C（P0.05）.The dose of tramadol was higher in group C than in group T and group R.Conclusion Preemptive analgesia with ketorolac tromethamine 30 mg has significant effect on postoperative pain relief after laparoscopic cholecystectomy without any influence on recovery time.But it does not relate to the time of drug given.