腹腔镜术后镇痛的临床研究

Clinical research of analgesia after laparoscopic surgery

目的观察比较腹腔镜术后4种不同镇痛方法的镇痛效果及患者术后应激反应指标的变化。方法 80例腹腔镜下行卵巢肿瘤切除术(LO)、子宫肌瘤剔除术(LH)和胆囊切除术(LC)病人,随机分成术毕伤口周围局麻药浸润镇痛组(LA),间断皮下注射吗啡镇痛组(SA),伤口周围局麻药浸润+间断皮下注射吗啡镇痛组(LSA)及病人自控静脉注射吗啡镇痛组(PCIA)四组,每组20例。术后4、8、16、24、36及48小时随访患者并记录VAS疼痛评分、Ramsay镇静评分、空腹血糖、血清皮质醇及术后不良反应情况。结果 LSA组和PCIA组患者在术后24小时内各时点的VAS疼痛评分、空腹血糖及术后第一日的血清皮质醇水平均低于LA组和SA组(P<0.05),而Ramsay镇静评分则SA组和PCIA组高于LA组和LSA组;PCIA组病人的不良反应发生率高于LA组和LSA组(P<0.05),而与SA组相近(P>0.05)。结论伤口周围局麻药浸润+间断皮下注射吗啡用于腹腔镜术后镇痛具有安全可靠、简单易行、效果确切、副作用少且经济实用等优点,是一种较好的腹腔镜术后镇痛方法。

Objective Observing and comparing the analgesic effects of four different analgesic methods and the pa- tients＇ stress response indexes after postoperative analgesia were applied. Methods 80 patients undergoing LO, LH and LC, were divided randomly into four groups. At the time points of 4, 8, 16, 24, 36, 48h after operation, VAS, Ramsay sedation scores, empty stomach blood sugar levels, serum cortisol and side effects were recorded. Results VAS and blood sugar level at the each time point within postoperative 24 hours and the serum cortisol level on the 1 st postoperative day in LSA and PCIA group were lower than those in LA and SA group （ P 〈 0. 05 ）, but Ramsay sedation scores in SA and PCIA group were higher than that in LA and LSA group ; The incidence of adverse reaction in PCIA group was higher than those in LA and LSA group （ P 〈 0. 05 ）, but compared with SA group, obvious difference was not found. Conclusion Local infiltration anesthesia around incision with local anesthetic plus subcutaneous injection with morphine is an ideal postoperative analgesic pattern for laparoscopic surgery.