罗哌卡因浸透的明胶海绵切口皮下植入对子宫切除术后疼痛的影响

Effects of incision subcutaneous implantation of ropivacaine soaked gelatin sponge on pain after hysterectomy

目的探讨罗哌卡因浸透的明胶海绵切口皮下植入对子宫切除术后的镇痛效果。方法选取2016年1月至2016年10月在海南省妇幼保健院接受择期子宫切除术的240例患者,采用随机数字表法分为A、B、C三组各80例,A组采用罗哌卡因浸透的明胶海绵切口皮下植入进行术后镇痛,B组术后直接静脉滴注0.5%罗哌卡因镇痛,C组置入明胶海绵后注射0.9%生理盐水,监测并对比三组术后疼痛、血流动力学等指标。结果 A、B两组患者术后1、4、8、12、24、48h的疼痛程度评分均低于同一时间点C组患者(F=51.204,P<0.05),A、B两组患者术后各时间点疼痛程度评分差异均无统计学意义(F=1.276,均P>0.05);A、B、C三组患者T0、T1、T2、T3、T4时刻的血氧饱和度(Sp O2)水平差异无统计学意义(F=2.057,均P>0.05);A、C组患者T1、T2、T3、T4时刻的平均动脉压(MAP)、心率(HR)监测值与本组T0时刻比较差异均无统计学意义(F值分别为2.684、1.419,均P>0.05),B组患者患者T1、T2时刻的M AP、HR监测值与本组T0时刻比较降低(t值分别为13.085、10.684,均P<0.05);A、C组患者的恶心呕吐、头痛发生率均低于B组(χ~2值分别为18.279、10.833,均P<0.05);A组的恶心呕吐发生率高于C组(χ~2=4.498,均P<0.05)。结论罗哌卡因浸透的明胶海绵切口皮下植入对子宫切除术后的镇痛效果显著,血流动力学影响小,具有较高的临床推广价值。

Objective To investigate the analgesic effect of incision subcutaneous implant of ropivacaine soaked gelatin sponge after hysterectomy. Methods Altogether 240 patients receiving elective hysterectomy in Maternal and Child Health - care Hospital of Hainan Province from January to October in 2016 were selected and divided with random number table method into groups A, B and C with 80 cases in each group. Patients in group A were treated with incision subcutaneous implantation of ropivaeaine soaked gelatin sponge for postoperative pain, patients in group B received direct infusion of 0.5% ropivacaine after operation for analgesia, and patients in group C were injected with 0.9% saline after gelatin sponge implantation. Postoperative pain and hemodynamic indexes of patients were monitored and compared among three groups. Results Pain score at 1,4, 8, 12, 24 and 48 hours after operation of patients in group A and B was all lower than that at the same time point of patients in group C （ F = 51. 204, all P 〈 0.05 ）. Pain score of patients between group A and B at each time point after operation had no statistical significance （ F = 1. 276, all P 〉 0.05 ）. There was no significant difference in blood oxygen saturation （ SpO2 ） level at T0, T1, T2, T3 and T4 among patients in group A, B and C （ F = 2. 057, all P 〉 0.05 ）. Monitoring values of mean arterial pressure （MAP） and heart rate （HR） at T1, T2, T3 and T4 of patients in group A and B were not significantly different from those of same group patients at TO （ F value was 2. 684 and 1. 419, respectively, both P 〉 0.05 ）. Monitoring value of MAP and HR of patients in group B at T1 and T2 were lower than those of same group patients at T0 （ t value was 13. 085 and 10. 684, respectively, both P 〈 0.05 ）. Incidences of nausea and vomiting and headache of patients in group A and C were both lower than those of patients in group B （χ2 value was 18. 279 and 10. 833, respectively, both P 〈 0.05 ）. Incidence of nausea and vomiting in group A was higher than that in group C （χ2 = 4. 498, P 〈 0.05 ）. Conclusion Incision subcutaneous implantation of ropivaeaine soaked gelatin sponge has significant analgesia effect after hysterectomy. It has small effect on hemodynamies and is highly worth spreading in clinical practice.