不同镇痛方法对妇科肿瘤患者术后康复的影响

Effect of different analgesic methods on postoperative rehabilitation of patients with gynecologic tumor resection

目的评估3种不同的镇痛方式对妇科肿瘤切除患者术后康复的影响。方法 90例在全麻联合硬膜外麻醉下行妇科肿瘤切除术的患者分为3组:A组术后采用静脉镇痛;B组术后采用硬膜外镇痛;C组术后采用硬膜外镇痛+术毕缝合切口时用0.25%罗哌卡因10mL进行局部浸润麻醉。分别记录患者在术毕4、8、24、48h的疼痛评分,以及术后患者首次排气的时间、第1次下床活动时间、术后住院时间、患者满意度、术后总治疗费用、观察不良反应的发生率等。结果 C组术后疼痛评分整体较A组和B组低,镇痛效果更好。术后排气时间,C组[(25.17±3.75)h]较A组和B组时间明显缩短(P<0.05),胃肠功能恢复更快;首次下床活动时间,C组[(17.30±2.22)h]较A组先下床活动(P<0.05),而B、C两组差异无统计学意义(P>0.05);术后住院时间A组[(5.12±0.52)d]显著长于C组(P<0.05),而B、C两组差异无统计学意义(P>0.05);术后治疗费用A组[(8 876.93±297.95)元]显著高于C组(P<0.05),B、C两组差异无统计学意义(P>0.05),C组满意度最高。结论联合罗哌卡因局部浸润+硬膜外镇痛的多模式镇痛方式能更有效控制疼痛,促进患者早期康复。

Objective To evaluate the effect of three different analgesic methods on postoperative rehabilitation of patients with gynecologic tumor resection.Methods 90 patients with gynecologic tumor resection under general anesthesia combined epidural anesthesia were randomly divided into three groups:group A received intravenous analgesia after operation,group B received epidural analgesia after operation;group C received epidural analgesia,and the incision was blocked by 10 ml of 0.25 % ropivacaine after operation.Pain score at 4,8,24 and 48 hours after operation,exhaust time for the first time,time of the first ambulation,duration of postoperative hospitalization,the patients′satisfaction,and the total cost of postoperative treatment were recorded respectively.And the incidence of adverse reactions was observed.Results The pain score in group C was lower than that in group A and B,and the analgesic effect was better.In observation of postoperative exhaust time for the first time,group C [(25.17±3.75)h]was shorter than group A and B(P<0.05),and the recovery of gastrointestinal function was faster.In the observation the first ambulation,group C[(17.30±2.22)h]had a statistical significance compared with group A(P<0.05),and there was no statistical difference between group B and C.The hospitalization duration after operation was significantly longer in group A [(5.12±0.52)days]than in group C(P<0.05),while there was no significant difference between group B and C.The postoperative cost of group A [(8 876.93±297.95)yuan]was significantly higher than group C(P<0.05),group B and C had no statistical difference.Group C had the highest degree of satisfaction.Conclusion The combination of ropivacaine local infiltration and epidural analgesia can effectively control the pain and promote the recovery of patients.