289例真皮层注射亚甲蓝与罗哌卡因配比液痔瘘术后镇痛的临床研究

Clinical research to 289 cases of dermal injection of Methylene Blue and Ropivacaine liquid for postoperative analgesia of hemorrhoidectomy

目的探讨真皮层注射亚甲蓝与罗哌卡因合用于痔瘘术后镇痛作用。方法将289例痔瘘患者随机分为4组,手术后给予不同处理:对照组1(n=72),质量浓度为0.009 g/m L的生理盐水于手术切口周围及肛周皮下点状或环状注射;对照组2(n=71),质量浓度为0.009 g/m L生理盐水于手术切口周围及肛周真皮层点状或环状注射;治疗组1(n=73),亚甲蓝/罗哌卡因于手术切口周围及肛周皮下点状或环状注射;治疗组2(n=73),亚甲蓝/罗哌卡因于手术切口周围及肛周真皮层点状或环状注射。采用视觉模拟量表法记录患者疼痛状况。结果对照组1(62.5%)和2(67.6%)解痛效率相近,无明显差异(P>0.05)。治疗组1镇痛有效率83.6%,治疗组2镇痛有效率95.9%,与对照组比,治疗组1和治疗组2镇痛效果显著(P<0.01)。治疗组2注射镇痛效果明显优于治疗组1(P<0.05)。结论亚甲蓝与罗哌卡因真皮层注射用于肛肠术后镇痛效果优于皮下注射,是一种更有效的创面止痛方法。

Objective To explore the analgesic effect of dermal injection of Methylene Blue combined with Ropivacaine after hemorrhoidectomy.Methods 289 sufferers with anal fistula were randomly divided into 4 groups and accepted different treatment after operation.Control group 1 （n = 72） received dot or ring injection around the incision and anal subcutaneous tissue of normal saline （NS） with mass concentration of 0.009 g/mL.Control group 2 （n = 71） received dot or ring injection around the incision and anal dermal tissue of normal saline（NS） with mass concentration of 0.009 g/mL.Treatment group 1 （n = 73） received dot or ring injection around the incision and anal subcutaneous tissue of Methylene Blue combined with Ropivacaine.Treatment group 2（n = 73） received dot or ring injection around the incision and anal dermal tissue of Methylene Blue combined with Ropivacaine.Visual Analogue Scale method was adopted to record the sufferers＇ pain status. Results There was insignificant change between control group 1 and 2 with similar analgesia rate of 62.5% and 67.6%（P 〉 0.05）.Analgesia rate in treatment group 1 and 2 was respectively 83.6% and 95.9%, which was clearly effective compared with the control groups（P 〈 0.01）.Analgesic effect in treatment group 2 was significantly better than that of treatment group 1 （P 〈 0.05）.Conclusion Dermal injection of Methylene Blue combined with Ropivacaine for postoperative analgesia of hemorrhoidectomy is better than subcutaneous injection, and it can be a more effective method for wound surface analgesia.