试论对行肝胆手术的患者进行不同的术后镇痛治疗对其胃肠动力的影响

Effect to gastrointestinal motility of different postoperative analgesia to the patients achieved hepatobiliary surgery

目的 :探讨对进行肝胆手术的患者进行不同的术后镇痛治疗对其胃肠动力的影响。方法 :将2013年至2016年期间在四川省古蔺县人民医院接受肝胆手术的159例患者作为研究对象。将这些研究对象随机分为A组、B组和C组,每组各有53例患者。对A组患者进行硬膜外自控镇痛治疗,对B组患者进行静脉自控镇痛治疗,对C组患者进行常规镇痛治疗。然后,比较三组患者手术的用时、术中的出血量、术后首次排气的用时、首次排便的用时、术后恶心呕吐的发生率及术后48 h的VAS(视觉模拟评分法)评分。结果 :B组患者手术的用时长于A组患者,A组患者的手术用时长于C组患者(P<0.05)。C组患者术后首次排气的用时及术后首次排便的用时均短于A组患者,A组患者术后首次排气的用时及术后首次排便的用时均短于B组患者(P<0.05)。在术后的48 h,B组患者在静息时和咳嗽时其VAS评分小于A组患者,A组患者在静息时和咳嗽时的VAS评分小于C组患者(P<0.05),C组患者在活动时的VAS评分大于B组患者,B组患者在活动时的VAS评分大于A组患者(P<0.05)。结论 :与进行静脉自控镇痛治疗相比,对实施肝胆手术后的患者进行硬膜外镇痛治疗的镇痛效果较差,但可促进其胃肠功能的恢复。

Objective： To explore effect to gastrointestinal motility of different postoperative analgesia to the patients achieved hepatobiliary surgery. Methods： Select 159 cases of patients achieved hepatobiliary surgery in People＇ s Hospital of Gulin County during 2013 to 2016 for research object. Randomly divide the cases to group A, group B and group C,53 cases each group, Treat group with Patient-controlled epidural analgesia （PCEA）,treat group B with patient - controlled intravenous analgesia（PCIA）,treat group C with routine analgesia. Then compare operation time, bleeding volume in operation, the first postoperative exhaust time, the first defecation time, incidence of nausea, and VAS score in postoperative 48h of 3 groups. Results： Operation time of group B is longer than that in group A, operation time of group A is longer than that in group C （ P 〈 0.05 ） . The first postoperative exhaust time and the first defecation time of group C is shorter than that in group A, the first postoperative exhaust time and the first defecation time of group A is shorter than that in group B （ P 〈 0.05 ） . In postoperative 48 h, VAS score of group B time are smaller than that in group A in tranquillization time and cough, VAS score of group A are smaller than that in group C in tranquillization time and cough time, VAS score of group C is bigger than that in group B in activity time, VAS score of group B is bigger than that in group A in activity time （ P 〈 0.05 ） . Conclusion： Compare with PCIA, the effect of treating the patients achieved hepatobiliary surgery with PCEA is worse, but PCEA will improve their recovery of gastrointestinal function.