罗哌卡因在高龄腹股沟疝无张力修补术中临床评价

The clinical evaluation of ropivacaine in tension-free repair for elderly inguinal hernia

目的总结分析局部注射罗哌卡因治疗患有合并症的高龄腹股沟疝的治疗效果及安全性评价。方法回顾性分析2012年1月至2013年11月,山西医科大学第二医院收治高龄腹股沟疝患者200例,随机分成二组,每组100例。二组患者均采用无张力疝修补术,A组采用利多卡因局部麻醉,B组采用罗哌卡因局部麻醉。结果二组患者麻醉手术时间、麻醉起效时间比较差异均无统计学意义(t=0.673、0,P=0.502、1)。B组麻醉效果、镇痛持续时间均高于A组,差异有统计学意义(χ2=106.71,P=0.001;t=74.261,P=0.001)。术中局麻药使用总量低于A组(t=7.593,P=0.001)。术中患者耐受良好,所有患者痊愈出院,平均住院4 d,术后尿潴留共18例,阴囊积液4例。所有患者均获得随访,随访3～12个月,无复发。结论局部注射罗哌卡因治疗患有合并症高龄腹股沟疝具有安全、快速、疗效好、镇痛效果等优点,明显降低手术风险、并发症、手术费用和住院时间,适合患有各类基础疾病及全身麻醉禁忌证的高龄腹股沟疝患者。

Objective To summarize and analyze the therapeutic effect and safety evaluation of local injection of ropivacaine therapy for inguinal hernia in elderly patients with comorbidity. Methods From January 2012 to November 2013, A total of 200 cases of elderly inguinal hernia admitted to Second Affiliated Hospital of Shanxi Medical University were retrospectively analyzed. Patients were randomly divided into two groups, 100 eases in each group. Tension-free hernia repair was performed to both groups： Group A used lidocaine for local anesthesia, and Group B used ropivacaine for local anesthesia. Results There were no significant differences in anesthesia time and onset time of anesthesia between two groups of patients （t = 0. 673,0, P = 0. 502, I ）. The anesthetic effect and duration of analgesiain Group B were significantly higher than those in Group A（X^2 = 106.71 ,P =0. 001 ,t =74. 261 ,P =0.001 ）. Dosage of local anesthetics in Group B was significantly less than in Group A （ t = 7. 593, P = 0.001 ）. All patients were well tolerated during operations, and discharged uneventfully in an average of 4 days. Postoperative urinary retention occurred in 18 cases, and scrotal hydrocele occurred in 4 cases. After the follow-up of 3 to 12 months, no recurrence was found. Conclusions Local injection of ropivacaine in treatment of inguinal bemia in elderly patients with comorbidity is a safe, fast, good analgesic effect method, which can significantly reduce the surgical risk, complications, cost of surgery and hospitalization stay. It is suitable for elderly inguinal hernia patients with different types of eomorbidity, or with contraindications of spinal anesthesia and general anesthesia.