不同局部麻醉方法对腹腔镜胆囊切除术患者术后切口镇痛的护理观察

The nursing observation of the postoperative incision of laparoscopic cholecystectomy with different juma methods

目的了解罗哌卡因局部麻醉使用时机和次数对减轻腹腔镜胆囊切除术后切口疼痛和舒适性的效果。方法前瞻性随访200例腹腔镜胆囊切除术患者,分为A、B、C、D组,每组50例。A组手术开始前、结束后分别在切口局部注射0.75%罗哌卡因10 mL。B组仅在手术结束后在切口处局部注射0.75%罗哌卡因10 mL,C组仅在手术开始前,在切口处局部注射0.75%罗哌卡因10 mL,D组为对照组,在切口注射生理盐水。观察4组患者麻醉苏醒时,回病房时,术后2、4、6 h疼痛视觉模拟评分(VAS)及血压波动情况。结果A、B、C组患者术后在麻醉恢复室苏醒后VAS明显低于D组,A、B、C组患者中麻醉苏醒后血压波动大于20%患者明显低于D组,差异均有统计学意义(P<0.05)。结论罗哌卡因切口局部麻醉能明显减少腹腔镜胆囊切除术后疼痛程度,但罗哌卡因局部麻醉应用的次数和时机对腹腔镜胆囊切除术后切口镇痛效果无明显影响。

Objective To investigate the effect of ropivacaine with local anesthesia of occasion and frequency in patients undergoing laparoscopic cholecystectomy(LC).Methods Two hundred patients undergoing LC were randomized to four groups with fifty patients each.Group A:preoperative and postoperative respectively received ropivacaine to infiltrate incision,group B:postoperative received ropivacaine to infiltrate incision,group C:preoperative received ropivacaine to infiltrate incision,group D:without ropivacaine.The VAS and blood pressure change of revival of anesthesia,back to impatient ward and 2,4,6 hours after operation were observed.Results Compared with group D,the VAS of incision pain at anesthesia recovery in group A(P<0.05),group B(P<0.05),group C(P<0.05)were significantly lower.Conclusion Ropivacaine with local anesthesia in LC can significantly reduce postoperative pain and don't effect the recovery of patients.However.