胃肠道微创手术后局部浸润麻醉联合氟比洛芬酯静脉镇痛效果的观察

Analgesic effect of local infiltration anesthesia combined with intravenous injection of flurbiprofen following minimally invasive surgery for gastrointestinal tract

目的观察罗哌卡因局部浸润麻醉联合氟比洛芬酯注射液静脉镇痛在胃肠外科微创手术后镇痛效果。方法选择124例胃肠道微创手术病人(手术方式包括腹腔镜下胃手术,腹腔镜下右半结肠根治性切除,腹腔镜下左半结肠根治性切除,腹腔镜下直肠全系膜切除术),采用随机数表法随机分为3组,罗哌卡因局部浸润麻醉+氟比洛芬酯注射液静脉滴注组(A组,41例),罗哌卡因局部浸润麻醉+生理盐水静脉滴注组(B组,42例),生理盐水局部注射+氟比洛芬酯注射液静脉滴注组(C组,41例)。采用视觉模拟疼痛评分量表(visual analogue scales,VAS)对病人术后各时间点即手术后即刻、术后1h、术后2h、术后4h、术后8h、术后12h以及术后24h疼痛程度进行评分;参照Ramsay镇静评分对病人镇静程度进行评分,观察3组病人胃肠道不良反应、胃肠道功能恢复时间及住院时间的长短。结果 A组VAS评分在术后4h、8h、12h及24h均低于B组和C组,差异均有统计学意义(均P<0.05);A组Ramsay评分在术后1h、2h、4h及8h均低于B组和C组,A组病人胃肠道功能恢复时间短于B组及C组,住院时间也短于B组和C组,差异均有统计学意义(均P<0.05)。结论罗哌卡因局部浸润麻醉联合氟比洛芬酯静脉镇痛在胃肠外科微创手术后的应用是安全有效的,不良反应少。

Objective To investigate the analgesic effect of ropivacaine local infiltration anesthesia combined with furbiprofen following minimally invasive surgery for gastrointestinal tract.Methods 124 patients were subjected to the minimally invasive surgical procedures including laparoscopic gastric surgery,laparoscopic radical resection of right colon,laparoscopic radical resection of left colon,and laparoscopic total mesorectal excision,and randomly divided into 3 groups by the random number table method：group A given the ropivacaine local infiltration anesthesia＋flurbiprofen,n=41;group B given ropivacaine local infiltration anesthesia＋normal saline intravenous infusion（n=42）,and group C（normal saline＋flurbiprofen,n=41）.The VAS scores,Ramsay score,the adverse reaction of gastrointestinal tract,the recovery time of gastrointestinal function and the average length of hospital stay were recorded.Results As compared with group B and group C,VAS scores at 4,8,12 and24 h after operation,and Ramsay scores at 1,2,4 and 8 h after operation were significantly reduced in group A.The recovery time of gastrointestinal function was shorter in group A than in group B and group C group.The average length of hospital stay in group A was shorter than in group B and group C.Conclusions Ropivacaine local infiltration anesthesia combined with flurbiprofen in minimally invasive surgery for gastrointestinal tract is safe and has less adverse reactions.