丙泊酚静脉全麻后复合罗哌卡因对腹腔镜子宫全切术后镇痛效果的临床观察

Clinical analysis of Propofol combined with Ropivacaine for Laparoscopic total hysterectomy anesthesia

目的探讨丙泊酚静脉全麻后复合罗哌卡因对腹腔镜子宫全切术后镇痛的效果。方法记录并统计分析2014年12月-2016年12月在本院接受腹腔镜子宫全切术治疗患者226例的临床资料。治疗上根据临床麻醉用药不同,采用随机数字法,把226例患者随机分为两组:对照组113例单纯静脉注射丙泊酚诱导并维持临床麻醉,治疗组113例给予丙泊酚+罗哌卡因联合麻醉。运用视觉模拟评分法(visual analogue scale,VAS)评估患者手术苏醒后24 h内腹腔脏器和切口疼痛程度(VAS评分>4分患者术后注射杜冷丁镇痛;采用R amsay Sedation Scale(R SS)镇静评分法评估镇静程度;术前、术后监测两组患者血浆皮质醇浓度,分析麻醉后相关恢复指标、术后疼痛、术后镇静情况、术后皮质醇浓度及术后恶心呕吐(postoperative nausea and vomiting,PO N V)的发生情况。结果麻醉后相关恢复指标治疗组优于对照组,差异有统计学意义(P<0.05);术后腹腔痛、切口痛VAS评分治疗组低于对照组,差异有统计学意义(P<0.05);术后皮质醇浓度治疗组低于对照组,差异有统计学意义(P<0.05);对照组术后追加镇痛患者68例,治疗组无追加镇痛患者,差异有统计学意义(P<0.01);术后恶心呕吐P0N V评分治疗组低于对照组,差异有统计学意义(P<0.05);术后镇静程度RSS评分治疗组与对照组比较,差异无统计学意义(P>0.05)。结论丙泊酚静脉全麻后联合罗哌卡因应用于腹腔镜子宫全切手术中具有较好的麻醉效果,在同样的镇静效果下能改善患者麻醉后恢复情况,降低术后24 h内的VAS评分,延长术后镇痛时间,减少术后恶心呕吐发生率值得在临床上推广应用。

Objective To investigate and compare the analgesia effect between propofol combined with ropivacaine and simple propofol for total hysterectomy under laparoscopy. Methods To analyze the clinical data of 226 patients with laparoscopic hysterectomy performed in the hospital between December 2014 and December 2016. According to clinical anesthesia drugs, 226 patients were randomly divided into two groups by random number method（n=113）, simple propofol anesthesia group（control group）and propofol plus ropivacaine anesthesia group（treatment group）. The degree of abdominal viscera and wound pain was revalued by visual analogue scale method（Visual Analogue Scale, VAS）, when VAS score was above 4, patients were injected analgesic.The degree of Sedation was revalued by Ramsay Sedation scale method（RSS）. anesthesia recovery index, VAS, RSS, plasma cortisol concentration, and postoperative nausea and vomiting（ PONV）were recorded. Results Compared with control group, the anesthesia recovery indexes in treatment group need shorter time（P〈0.05）; the VAS score, PONV score and the postoperative cortisol concentration in treatment group are lower（P〈0.05）; Nobody received additional analgesia in the treatment group, but 68 patients in the control group received additional analgesia（P〈0.01）.In the RSS score, there is no difference between the treatment group and the control group（P〈0.05）. Conclusion Propofol combined with ropivacaine for laparoscopic total hysterectomy produces good anaesthesia effect and sedative effect, at the same time, it can improve patients＇ anesthesia recovery conditions, reduce the postoperative VAS score, extend the time of postoperative analgesia, reduce the incidence of postoperative nausea and vomiting, so it is worth popularization and application in clinic.