芬太尼静脉自控镇痛的应用对腹腔镜胆囊切除术后患者的影响

The Impact of Fentanyl Patient Controlled Intravenous Analgesia on Laparoscopic Cholecystectomy

目的前瞻性研究应用芬太尼静脉自控镇痛(patient controlled intravenous analgesia,PCIA)对腹腔镜下胆囊切除术(laparoscopic cholecystectomy,LC)患者围手术期的镇痛效果以及不良反应。方法观察对象为2012年1月至2013年3月我科完成的LC患者总共76例。其中有6例因合并胆总管结石复杂胆管结石,4例术中转开放而退出观察。观察剩余患者术后镇痛效果、不良反应发生率、肛门排气时间、术后住院时间。结果剩余66例有25例术后使用芬太尼PCIA为观察组(n=25),41例未使用或仅肌肉注射哌替啶注射液镇痛为对照组(n=41)。两组患者的平均疼痛评分分别为(3.3±1.2 vs 3.7±1.6)(P>0.05);观察组消化道不良反应发生率,止吐药物应用率、坐起时眩晕发生率均高于对照组,分别为52%vs 26.8%(P<0.05),40%vs 17.1%(P<0.05);40%vs 12.2%(P<0.01)。观察组手术当晚肛门排气率显著低于对照组,56%vs 85.4%(P<0.05);两组术后平均住院时间无显著差异。结论 LC术后应用芬太尼PCIA的镇痛效果与不用相比并没有显示出明显的优势。由于其较高的不良反应发生率,常规应用PCIA进行LC术后镇痛的必要性还有待商榷。

Objective The aim of this study was to assess the impact of fentanyl patient controlled intravenous analgesia （PCIA） on elective laparoscopic cholecystectomy （LC）. Methods In a prospective, non-randomised, observational study, 76 consecutive patients who underwent elective in-patient laparoscopic cholecystectomy during Jan 2012-Mar 2013 in our department were reviewed. Six patients with complicated gall stone disease and four patients who converted from laparoscopic to an open opera- tion were excluded. The analgesic effect, the incidence of adverse reactions, anus exhausting time, and postoperative hospital stay were observed. Results Of the 66 remaining in the study group, 25 patients received fentanyl-PCIA. In contrast, 41 patients did not receive PCIA. Average VAS score in the PCIA group was 3.3 ± 1.2 and in the non-PCIA group 3.7± 1.6 （P 〉 0.05）. Post- operative nausea and vomiting were more common in patients receiving a fentanyl-PCIA（52% in PCIA and 26.8% in non-PCIA groups,P 〈 0.05） and with in those with higher anti-emetic requirement （40% in PCIA and 17.1% in non-PCIA groups, P 〈 0. 05）. Conclusion Routine postoperative fentanyl PCIA prolongs the recovery following elective laparoscopic cholecystectomy. Its role in postoperative pain management in routine laparoscopic cholecystectomy should be questioned.