复方美蓝制剂对胸腔镜术后镇痛疗效评价的影响

Effect of compound coeruleum methylenum preparation on postoperative analgesia after thoracoscopic surgery

目的对复方美蓝制剂用于胸腔镜术后镇痛的效果进行观察，以期为胸腔镜患者术后镇痛药物的选择提供新的思路。方法分析2016年1月一2018年5月在广东省揭阳市人民医院心胸外科择期行胸腔镜手术的116例患者的临床资料。本次研究属前瞧性研究，采用随机数字表法将其分为对照组（n=57）和观察组（n=59）。两组患者术前均不应用任何镇痛措施，其中对照组患者术后给予常规盐酸哌替啶肌肉注射镇痛；观察组患者术后应用复方美蓝行肋间神经阻滞，每个肋间应用复方美蓝制剂1ml，术后盐酸哌替啶应用条件与对照组相同。比较两组患者术后4、12、24、48h时静息状态和活动状态下的视觉模拟评分（VAS）及Ramsay镇静评分，比较两组患者术后3d内盐酸哌替啶使用量及药物不良反应发生情况，记录和比较两组患者的下床活动时间和住院时间。计数资料采用百分比（％）的形式表示，组间比较行X。检验；计量资料采用均数±标准差（面-4-s）表示，组内不同时间点的比较应用单因素方差分析，应用独立样本t检验进行两组问比较。结果观察组患者术后12、24、48h时静息状态下的VAS[12h：（2．68±1．24）分；24h：（1．35±1．16）分；48h：（0．74±0．63）分]和活动状态下的VAS[12h：（3．81±1．53）分；24h：（3．85±1．97）分；48h：（0．74±1．33）分]均显著低于对照组[静息状态下12h：（3．85±1．97）分；24h：（2．74±1．91）分；48h：（2．11±1．70）分；活动状态下12h：（5．02±1．64）分；24h：（4．89±1．36）分；48h：（3．83±1．51）分]。术后12h和24h时的Ramsay评分[12h：（2．93±0．35）分；24h：（2．79±0．30）分]显著高于对照组[12h：（12．58±0．41）分；24h：（2．29±0．54）分]，差异均具有统计学差异（P〈0．05）；观察组患者术后3d内盐酸哌替啶使用量显著少于对照组，其下床活动时间和住院时间均显著短于对照组，差异均具有统计学意义（P〈0．05），两组患者镇痛相关不良反应发生率分别为35．09％和27．12％，差异无统计学意义（P〉0．05）。结论啕腔镜手术患者术后给予复方美蓝制剂镇痛效果确切，维持时间长，而且其不良反应少、操作方便，值得临床推广应用。

Objective To observe the analgesic effect of compound coeruleum methylene blue preparation after thoracoscopic surgery, and to provide a new idea for the choice of analgesic drugs for thoracoscopic patients. Methods The clinical data of 116 patients who underwent selective thoracoscopic surgery in the Department of Cardiothoracie Surgery of Jieyang People＇s Hospital from January 2016 to May 2018 were analyzed, This study was a prospective study. Research subjects were divided into control group （ n = 57 ） and observation group （ n = 59 ） by random digital table. In the two groups, no analgesic measures were used in advance, of which the patients in the control group were given the routine injection of piperidine hydroehloride by intramuscular injection after operation. While patients in the observation group were given intercostal nerve block across the upper and lower ribs after operation, and the dosage of compound methylene blue was 1 ml in each rib. on the basis with pethidine hydrochloride. The visual analog score and Ramsay sedation score were compared between the two groups of patients at 4 h, 12 h 24 h and 48 h after operation and compared the use of pethidine hydrochloride, adverse drug reactions,ambulation time and hospitalization time. The counting data was expressed in terms of frequency and percentage （ % ）. The measurement data were represented by （ x ± s）. The comparison of different time points within the group was performed by single-factor analysis of variance, and the comparison between the two groups was performed by independent sample t test. Results Compared with the control group＇ s patients[ in resting state, 12 h： （3.85 ± 1.97） points; 24 h：（2.74 ± 1.91） points; 48 h： （2. 11 ± 1.70） points; in activity state, 12 h： （5.02 ± 1.64） points; 24 h： （4.89 ± 1.36）points; 48 h： （3.83 ± 1.51 ） points], the VAS scores of the patients in the observation group in resting state [12 h：（2.68 ± 1.24） points; 24 h： （ 1.35 ± 1. 16） points; 48 h： （0.74 ± 0.63） points] and activity state[12 h： （3.81 ± 1.53） points; 24 h： （3.25 ± 1.71） points; 48 h： （2.42 ± 1.33）points] were significantly lower at 12 h, 24 h and 48h after operation. Compared with the control group＇s patients 12 h - （2.58 ± 0.41 ） points ] and 24 h [ （ 2.29 ± 0.34） points ], the Ramsay scores were significantly higher at 12 h[（2.93 ±0.35）points] and 24 h [（2.79 ±0.30）points] after operation （P〈0.05）. The observation group＇s amount of piperidine hydrochloride was less, and the ambulation and hospitalization time were shorter than the control group＇s （P 〈 0.05）. The incidence of analgesia - related adverse reactions in the control group and the observation group were 35.09% and 27. 12% , respectively, with no significant difference （P 〉 0.05）. Conclusions Compound coeruleum methylenum＇s analgesic effect after thoracoscopic surgery is accurate and maintains long time, and the side effects are less and the operation is convenient. It is worthy of clinical application.