局部浸润麻醉联合静脉自控镇痛在老年患者剖腹探查术后镇痛效果的观察

The antalgic effect observation of local infiltration anaesthesia combined with patient-controlled intravenous analgesia in elderly patients after laparotomy

目的观察局部浸润麻醉联合静脉自控镇痛在老年患者剖腹探查术后的镇痛效果。方法拟行剖腹探查术的老年患者60例,随机分为局部浸润联合静脉自控镇痛组(A组)、局部浸润联合静脉自控生理盐水组(B组)和局部浸润生理盐水联合静脉自控镇痛组(C组)3组。记录各组患者术后1小时、2小时、4小时和8小时视觉模拟评分(VAS),各组静脉自控镇痛泵按压次数,不良反应,胃肠道功能恢复及住院时间。结果 1小时、2小时、4小时VAS分别为2.6,3.3和3.4,A组分别为1.9,2.1和2.3,B组分别为2.0,2.0,和2.4。与C组比较,A组和B组明显降低,术后8小时,B组VAS评分(4.3)显著高于A组和C组(2.7,3.4),差异有统计学意义(P<0.05);随着术后时间的延长各组患者按压镇痛泵次数明显增多,B组在8小时按压次数(18)显著上升(P<0.05);三组或者呼吸遗忘发生率、住院时间比较,差异无统计学意义(P>0.05),而B组术后恶心呕吐发生率和胃肠道功能恢复与其他两组比较,差异有统计学意义(P<0.05)。结论局部浸润麻醉联合静脉自控镇痛可满足老年患者剖腹探查手术后的镇痛需求,不良反应少。

Objective To investigate the antalgic effect of local infiltration anaesthesia combined with patient-controlled intravenous analgesia（ PCIA） in elderly patients after laparotomy. Methods Sixty elderly patients scheduled for laparotomy were randomly devided into three groups,local infiltration anaesthesia combined with PCIA group（ group A）,local infiltration anaesthesia combined with intravenous selfcontrolled infusion of saline group（ group B）,local infiltration injection of physiological saline combined with PCIA group（ group C）. The visual analogue scale（ VAS） score at 1 h,2 h,4 h,8 h after operation,the press times of PCIA,the adverse reactions,the recovery of the gastrointestinal function and the duration of hospitalization were recorded. Results Compared with group C（ 2. 6,3. 3,3. 4）,the VAS scores in group A（ 1. 9,2. 1,2. 3） and group B（ 2. 0,2. 0,2. 4） were significantly lower within 4 hours（ 1 h-,2 h-,4 h-） after operation. However,at 8 h postoperatively,VAS scores of group B（ 4. 3） were significantly higher than those of group A（ 2. 7） and group B（ 3. 4）（ P〈0. 05）; With the prolongation of postoperative time,the press times of the PCIA were significantly increased,especially in group B（ 18） at 8 h postoperatively（ P〈0. 05）; there were no significant differences in the incidence of respiratory amnesia and the duration of hospitalization between the three groups（ P〉0. 05）,while the incidence of postoperative nausea and vomiting（ 7） and gastrointestinal function recovery（ 1. 6） in group B were significantly different（ P〈0. 05）.Conclusion Local infiltration anaesthesia combined with intravenous patient-controlled analgesia can satisfy the analgesia effect of elderly patients after laparotomy and less adverse reactions.