切口局部浸润超前镇痛对开腹患者术后康复的影响

Effect of preemptive analgesia with local wound infiltration on postoperative recovery of patients undergoing laparotomy

目的评估切口局部浸润超前镇痛对开腹患者术后康复的影响。方法选择2018年4月至2019年2月行开腹结直肠手术的成年患者120例,采用随机数字表法分为切口局部浸润组(L组)和对照组(C组),每组60例。在切皮前10 min,沿切口方向按每侧切口每1 cm注射1 ml药物的方法行切口局部浸润:L组(0.5%罗哌卡因),C组(0.9%生理盐水)。记录两组患者不同时刻的心率和平均动脉压、术后24 h补救镇痛药(舒芬太尼和吗啡)消耗量及术后静息状态的疼痛数字评价量表(NRS)、术后恢复情况和伤口愈合情况。结果观察期间,切皮即刻、手术结束时、拔管即刻、拔管后10 min的心率(HR)和平均动脉压(MAP),术后2、4、6 h静息时NRS评分,术后首次排气、首次排便、恢复正常饮食时间和住院时间,L组均显著低于C组,差异有统计学意义(P<0.05,P<0.01);而术后24 h的吗啡和舒芬太尼消耗量,术后12、24 h静息时的NRS评分以及伤口愈合时间、伤口愈合分级情况,两组间差异无统计学意义(P>0.05)。结论在开腹手术前行切口局部浸润超前镇痛,可使围术期血流动力学更加平稳,同时能够减轻术后早期疼痛程度和改善术后胃肠功能,在促进术后快速康复等方面具有重要的临床意义。

Objective To investigate the effect of preemptive analgesia with local wound infiltration(LWI) on postoperative recovery in patients undergoing laparotomy.Methods A total of 120 adult patients who underwent open colorectal surgery from April 2018 to February 2019 were randomly divided into LWI group(L group,n=60) and control group(C group,n=60).At 10 minutes before skin incision,LWI was performed by injecting 1 ml of drug per 1 cm along the incision direction in group L(0.5% ropivacaine) and group C(0.9% saline).Heart rate(HR) and mean arterial pressure(MAP) at different time,consumption of salvage analgesics(sufentanil and morphine) at 24 hours after operation,numerical rating scale(NRS) of pain on resting state,postoperative recovery and wound healing were recorded and compared in both groups.Results HR and MAP at the time of skin incision,at the end of operation,at extubation and 10 minutes after extubation,NRS score at rest at 2-,4-and 6-hour after operation,the time of first exhaust,first defecation,returning to normal diet and hospital stay in group L were significantly lower than those in group C(P<0.05).There were no significant differences in the consumption of morphine and sufentanil in 24 hours after operation,NRS score at rest 12-and 24-hour after operation,wound healing time and wound grade on healing between two groups(P>0.05).Conclusion In the patients undergoing laparotomy,preemptive analgesia with LWI can make perioperative hemodynamics more stable,reduce early pain after operation,improve gastrointestinal function and has important clinical significance in promoting rapid recovery after operation.