混合痔术后多模式镇痛的效果分析

Efficacy analysis of multimodal analgesia after operation of mixed hemorrhoids

目的探讨混合痔患者术后多模式镇痛的效果。方法选取2016年1月至2017年11月阜阳市中医医院90例美国麻醉医师协会(ASA)分级为Ⅰ~Ⅱ级混合痔拟行手术的患者。采用随机数字表法分为A、B、C 3组,每组各30例。术后A组患者单纯采用0.596%甲磺酸罗哌卡因注射镇痛;B组患者采用舒芬太尼联合格拉司琼连续静脉滴注镇痛;C组患者在B组的基础上,联合盐酸纳布啡肌内注射镇痛。比较3组患者围手术期疼痛视觉模拟评分(VAS)、不良反应、镇痛满意度及睡眠质量评分情况。结果 C组各时点VAS评分低于A、B组,差异均有统学意义(P<0.05);A、B、C组患者术后头晕、嗜睡、恶心呕吐、尿潴留、皮肤瘙痒不良反应发生率分别为(13.33%、0.00%、13.33%、20.00%、0.00%)、(20.00%、6.67%、26.67%、23.33%、6.67%)、(23.33%、6.67%、26.67%、20.00%、3.33%),差异均无统计学意义(P>0.05);C组患者术后镇痛满意度及睡眠质量评分[93.30%(4.36±1.47)分]高于A组[36.67%,(7.58±1.95)分]、B组[70.00%,(5.49±1.62)分],差异均有统计学意义(P<0.05)。结论混合痔手术术后采用多模式镇痛方法能够明显减轻患者疼痛剧烈程度,有助于术后睡眠,提高患者满意度,并不增加不良反应发生率。

Objective To observe the effect of postoperative multimodal analgesia on those patients with mixed hemorrhoids. Methods Ninety patients with grade I - II mixed hemorrhoids,based on classification of the American Society of Anesthesiologists（ ASA）,underwent operations in our hospital between Jan 2016 and Nov 2017,were collected and divided into 3 groups by means of random number table,30 cases in each group. After operation,patients in group A were locally injected with single 0. 596% ropivacaine mesylate for infiltration analgesia; group B were intravenously injected with sufentanil and granisetron for infusion analgesia;and group C were intramuscularly injected with nalbuphine hydrochloride on the basis of infusion analgesia in group B.The scores of pain visual analogue scale（ VAS）,adverse reactions,analgesia satisfaction and scores of sleep quality during the perioperative period in the three groups were recorded and compared. Results The VAS scores at each time points in group C were significantly lower than those in group A and B（ all P〈0. 05）. The incidence rates of such postoperative adverse reactions as dizziness,drowsiness,nausea and vomiting,urine retention and pruritus of skin were 13. 33%,0. 00%,13. 33%,20. 00% and 0. 00% in group A; 20. 00%,6. 67%,26. 67%,23. 33% and 6. 67% in group B; and 23. 33%,6. 67%,26. 67%,20. 00% and 3. 33% in group C,respectively,but no significant difference was found among the three groups（ P〉0. 05）. Patients in group C had significantly higher postoperative analgesia satisfaction（ 93. 30%） and sleep quality score（ 4. 36 ± 1. 47） than those in group A（ 36. 67%; 7. 58 ± 1. 95） and B（ 70. 00%; 5. 49 ± 1. 62）（ P〈0. 05）. Conclusion Application of multimodal analgesia after the mixed hemorrhoids surgery could evidently reduce the pain severity of patients,promote their sleep and improve their satisfaction,without the rising incidence of adverse reactions.