罗哌卡因术毕切口浸润在腰椎手术术后镇痛中的应用

Application of Ropivacaine in Postoperative Incision Infiltration in the Postoperative Analgesia of Lumbar Spine Surgery

目的观察腰椎手术全身麻醉术毕切口浸润罗哌卡因对术后镇痛及镇静的临床疗效。方法选取2013年1月至2014年1月于解放军总医院第一附属医院行腰椎手术患者98例,采用随机数字表法分为两组,各49例。试验组手术结束后用罗哌卡因在切口处逐层浸润,对照组手术结束后用0.9%Na Cl溶液在切口处逐层浸润。记录患者拔管后即刻及术后4、8、12、24 h视觉模拟量表(VAS)评分和Ramsay镇静评分结果,以及患者术后不良反应的发生率。结果试验组和对照组拔管后即刻及术后2、4、8、12 h VAS评分为(1.2±0.6)分,(1.3±0.9)分,(2.3±1.0)分,(3.3±1.3)分,(3.0±1.1)分,(2.6±1.0)分;(2.6±1.0)分,(3.4±1.3)分,(3.8±1.5)分,(4.0±1.4)分,(4.5±1.1)分,(2.8±1.0)分,Ramsay分别为(2.2±0.3)分,(2.3±0.9)分,(2.5±0.7)分,(2.3±0.6)分,(2.2±0.8)分,(2.3±0.7)分;(3.6±0.8)分,(3.3±0.7)分,(3.5±0.6)分,(3.6±1.0)分,(3.5±0.8)分,(3.4±0.9)分。试验组拔管后即刻及术后2、4、8、12 h VAS和Ramsay评分低于对照组,差异有统计学意义(P<0.05)。同时两组患者术后不良反应发生率分别为30.6%和44.9%,差异有统计学意义(P<0.05)。结论腰椎手术术毕用罗哌卡因逐层浸润手术切口可明显降低术后早期VAS评分,镇痛效果明显。

Objective To observe the clinical efficacy of postoperative ropivacaine incision infiltration in the postoperative analgesia and sedation of lumbar spine surgery.Methods A total of 98 patients in the First Affiliated Hospital of PLA General Hospital during Jan.2013 and Jan.2014 for lumbar spine surgery were included in the study,and were randomly divided into two groups,49 cases in each group.The trial group was administered ropivacaine infiltration in the incision after surgery.The control group was adminis-tered physiological saline infiltration in the incision after surgery.The postoperative 4,8,12,24 h visual ana-logue scale（VAS） scores and Ramsay sedation scores after extubation were recorded,and incidence of the postoperative adverse reactions was recorded as well.Results VAS immediately after tracheal extubation and postoperative 2,4,8,12 h in the trial group and control group：（1.2 ±0.6） scores,（1.3 ±0.9） scores, （2.3 ±1.0） scores,（3.3 ±1.3） scores,（3.0 ±1.1） scores,（2.6 ±1.0） scores;（2.6 ±1.0） scores, （3.4 ±1.3） scores,（3.8 ±1.5） scores,（4.0 ±1.4） scores,（4.5 ±1.1） scores,（2.8 ±1.0） scores, Ramsay were （2.2 ±0.3） scores,（2.3 ±0.9） scores,（2.5 ±0.7） scores,（2.3 ±0.6） scores,（2.2 ± 0.8） scores,（2.3 ±0.7） scores;（3.6 ±0.8） scores,（3.3 ±0.7） scores,（3.5 ±0.6） scores,（3.6 ± 1.0） scores,（3.5 ±0.8） scores,（3.4 ±0.9） scores.VAS and Ramsay in the trial group were lower than those of the control group,with statistically significant difference （P〈0.05）.The adverse reactions rate of the trial group was 30.6%,of the control group was 44.9%,the difference was statistically significant （ P〈0.05）.Conclusion Lumbar surgery with ropivacaine incision infiltration can significantly reduce early post-operative VAS score,has obvious analgesic effect is obvious.