联合镇痛在肛肠病手术中的应用价值

Value of Combined Analgesia Applied to Surgery for Anorectal Diseases

为探讨联合镇痛在肛肠病手术中的应用价值，将2012年3月至2013年1月拟在腰硬联合麻醉下行手术治疗的120例肛肠病患者随机分为A、B、C3组，每组40例，A组手术结束前创面注射速卡亚甲蓝混合液，术后行硬膜外自控镇痛（PCEA）48h，术后第3天开始静脉注射帕瑞希布钠3d，术后每次换药前30min用双氯芬酸钠栓1枚纳肛；B组手术结束前创面注射速卡亚甲蓝混合液，术后口服布洛芬缓释胶囊；C组术毕不进行任何镇痛处理。对比分析3组患者镇痛总体疗效，以及术后3h、6h、12h、24h、48h、72h、第5天及首次排便和换药时的疼痛（VAS）评分。结果显示，A组镇痛总有效率明显高于B、C组，B组镇痛总有效率明显高于C组，P＜0．05；A组术后3h、6h、12h、24h、48h、72h、第5天及首次排便和换药时VAS评分均明显低于B、C组，B组均明显低于C组，P＜0．05。结果表明，肛肠病术后联合镇痛能明显减轻患者疼痛。

This study was to explore the value of combined analgesia applied to surgery for anorectal diseases. The 120 patients with anorectal diseases to be subjected to surgery under associated sphinal and epidural anesthesia from March 2012yr. to Jan. 2013yr. were randomly divided into three group：A,B,C,40 cases per group. Then,concrete management was following as.in group A before the end of operation injecting mixed solution of levobupivacaine and methylene blue on the wound surface,after operation performing patient-controlled epidural analgesia（PCEA） for 48 hrs. ,on the 3rd day after operation starting to intravenously inject parecoxib sodium totally for 3 days, and 30min before each postoperative dressing change anal administering one diclofenac sodium supposity; in group B before the end of operation on the wound surface injecting mixed solution of levobupivacaine and methylene blue,after operation orally administering Ibuprofen delayed-release capsule;in group C after operation not performing any analgesia management. Finally,the whole efficacies,and VAS score ratings at 3,6,12,24,48,72 hrs. and on the 5th day after operation and when first defecation and dressing change in above three groups were compared and analyzed. As results,in total effective rate A〉B and C,B〉C significantly（ P〈0.05） ;in VAS score ratings A〈B and C,B〈C significantly（ P〈0.05）. Above results show that after operation for anorectal diseases combined analgesia can distinctly relieve pain of patient.