骶管术后自控镇痛及新斯的明预防尿潴留用于肛门手术的临床研究

Postoperative self-controlled analgesia with caudal and preventing urinary retention by using Neostigmine used in operation of anal disease

目的探讨连续骶管麻醉用于肛门手术后患者自控镇痛(PCA)的安全性和有效性及新斯的明预防尿潴留的效果。方法选择行肛门手术患者228例,ASAⅠ或Ⅱ级,随机分为2组:采用连续骶管麻醉及术后患者自控镇痛160例为A组(其中82例手术结束后肌注新斯的明为A1组,78例未用新斯的明为A2组),将同期采用单次骶管麻醉及术后传统镇痛方法68例作为对照组B组(其中40例手术结束后肌注新斯的明为B1组,28例未用新斯的明为B2组)。两组均采用1.5%利多卡因15～20ml进行麻醉,A组术后镇痛仅使用PCA技术参数中的单次给药剂量,药物为0.18%罗哌卡因,按压剂量6～7ml,锁定时间90min。A1和B1组手术结束后肌注新斯的明10μg/kg。观察两组患者术后48h内镇痛效果、睡眠状况及尿潴留情况。结果 A组患者术后镇痛效果、睡眠状况及排尿状态均优于B组(P<0.05),手术结束后肌注新斯的明预防尿潴留的比较无统计学意义(P>0.05)。结论连续骶管术后PCA用于肛门手术患者效果确切、安全、不良反应少,但手术结束后肌注新斯的明并不能降低尿潴留的发生率。

Objective To investigate the safety and effect of coutinuous caudal anesthesia for postoperative PCA（patient controlled analgesia） after operation of anal disease and the clinical effect of preventing urinary retention by using neostigmine. Methods Two hundred twenty-enght patients with ASA I or II underwent operation of anal disease were randomly divided into two groups： A group and B group. 160 patients of anal operation with coutinuous caudal anesthesia and postoperative PCA were taken as A group（82 patients were gived an intramuscular injection of 10 p.g/kg neostigrnine after operation were takes as A1 group and 78 patients were not gived neostigrnine after operation were takes as A2 group）. Homochronous,68 patients of anal operation had a single caudal anesthesia and postoperative analgesia of traditional methods were taken as control B group（40 patients who were gived an intramuscular injection of 10 μg/kg neostigrnine after operation were taken as control BI group. 28 patients were not gived neostigrnine after operation were takes as B2 group）. 15--20 ml 1. 5% lidocaine was used for anesthesia in both groups. Only single dose of PCA technical parameters was used in A group for analgesia,drug was 0.18% ropivacaine,6--7 ml every time,needing 90rnins totally. 10 μg/kg neostigrnine was used after operation in Aland B1 groups. Analgesia effect, sleep status and urinary retention were observed in 48 hours after operation. Results A group was superior to I5 group in postoperative analgesia,sleep status,and urinary retention（ P〈0. 05 ）. An intramuscular injection of neostigmine after operation was not significant difference（P〉0. 05）. Conclusion Continuous caudal anesthesia and postoperative PCA which was used for patient of anal disease proved to be a safe and effective,and also few adverse effects method, but an intramuscular injection of neostigrnine after operation could not effectively prevent urinary retention.