加速康复外科理念下不同镇痛方式对肝切除术后早期康复的影响

Effects of different analgesia methods on early rehabilitation after hepatectomy under the strategy of enhanced recovery after surgery

目的比较切口浸润联合静脉镇痛与硬膜外镇痛对肝切除术患者术后疼痛及早期康复的影响。方法选择择期行加速康复外科(enhanced recovery after surgery,ERAS)肝部分切除术的患者48例,男37例,女11例,年龄40~65岁,ASAⅠ或Ⅱ级,随机分为两组:切口浸润联合静脉镇痛组(T组),关腹前用0.375%罗哌卡因30ml切口逐层浸润联合PCIA;硬膜外镇痛组(E组),术后行单纯0.2%罗哌卡因100ml PCEA。两组均在缝皮前约30min静脉注射帕瑞昔布钠40mg。记录术后2、6、12、24和48h静息和运动时疼痛VAS评分,术后第1、2和3天的活动距离,第1次下床活动时间,术后住院时间和术后不良反应情况。结果 E组术后12、24和48h静息和运动时VAS评分明显低于T组(P<0.05),但两组VAS评分均<4分;T组术后第1天、第2天和第3天活动距离明显长于E组(P<0.05);T组术后第1次下床活动时间和术后住院时间明显短于E组(P<0.05);两组恶心呕吐、头痛、皮肤瘙痒、低血压、尿潴留等发生率差异无统计学意义。结论与单纯硬膜外镇痛比较,切口浸润联合静脉镇痛更有利于肝切除术患者早期下床活动,缩短住院时间,促进术后康复。

Objective To compare the effectiveness of postoperative analgesia and early rehabilitation between the wound infiltration combined with intravenous analgesia and epidural analgesia after hepatectomy.Methods Forty-eight patients with liver carcinoma,37 males and 11 females,aged 40-65 years,ASA physical statusⅠ orⅡ,were randomly divided into two groups.Patients in group T were given 0.375% ropivacaine 30 ml for incision infiltration before closing the abdomen and intravenous analgesia.Patients in group E were given 0.2% ropivacaine 100 ml for epidural analgesia.Pareoxib sodium 40 mg was injected intravenously 30 min toward the end of the operation.Pain scores were assessed by VAS at postoperative 2,6,12,24 and 48h.Postoperative activity distance was recorded on 1st,2nd,3th day after surgery;the time first getting off bed and hospital stay were recorded.Finally,the complications were also recorded.Results Compared with group T,VAS scores at rest and in activity 12,24 and 48hpostoperatively were significantly lower（P〈0.05）.Compared with group E,postoperative activity distance on 1st,2nd and 3th day after surgery in group T were shorter.Furthermore,the time first getting off bed and the hospital stay in group T were shorter than those in group E（P〈0.05）.The incidence of adverse reactions between the two groups had no statistical significance.Conclusion The wound infiltration combined with intravenous analgesia is beneficial to early recovery and shorter hospital stay.