QOR40量表对腹腔镜下子宫肌瘤剥除术应用酮咯酸氨丁三醇患者早期康复质量评估的应用研究

Study on application of QOR40 scale in early rehabilitation quality of patients with ketorolac tromethamine in laparoscopic uterine myomectomy

目的探讨40项恢复质量评分量表(QOR40)及其他指标对腹腔镜下子宫肌瘤剥除术应用酮咯酸氨丁三醇患者早期康复质量评估。方法选择喉罩置管全身麻醉下行腹腔镜下子宫肌瘤剥除术手术的患者60例,随机双盲分为酮咯酸氨丁三醇组(T组)和舒芬太尼组(S组)。术前30 min予T组酮咯酸氨丁三醇30 mg(1 mL)入壶静脉滴注,S组予1 mL生理盐水入壶静脉滴注。两组均常规静脉诱导喉罩插管全身麻醉术中异丙酚及瑞芬太尼针维持麻醉,术毕即刻给予患者自控镇痛泵(PCIA)100 mL,T组PCIA静脉泵药物配比为舒芬太尼1.0μg/kg+酮咯酸氨丁三醇3.0 mg/kg+盐酸帕洛诺司琼0.25 mg,S组PCIA静脉泵药物配比为舒芬太尼2.0μg/kg+盐酸帕洛诺司琼0.25 mg,两组皆设定负荷剂量5 mL,背景剂量2 mL/h,锁时15 min,自控剂量为2 mL。观察记录术前评估QOR40量表(QOR40-Pre)评分,术后第1天QOR40(QOR40-POD1)评分、术后第2天QOR40(QOR40-POD2)评分及其子指标情绪状态、疼痛感受、自理能力、心理支持,身体舒适度等评分,并记录满意度、住院时间、镇痛泵按压次数、镇痛补救次数、镇吐补救次数等指标。结果T组QOR40-POD1评分高于S组(P<0.05);在QOR40的5个子指标中,T组术后第1、2天的情绪状态指标高于S组(P<0.05);身体舒适度T组术后第1天高于S组(P<0.05);T组住院满意度高于S组,镇吐补救次数比S组少(P<0.05)。结论腹腔镜下子宫肌瘤剥除术患者围术期应用酮咯酸氨丁三醇能明显改善患者术后QOR40评分,减少并发症对早期康复有积极的临床意义。

Objective To investigate the early recovery quality evaluation of the QOR40 scale in the patients using ketorolac tromethamine undergoing laparoscopic uterine myomectomy.Methods Sixty patients with laparoscopic uterine myomectomy under general anesthesia with laryngeal mask catheter placement were selected and divided into the ketorolac tromethamine group(T group)and sufentanil group(S group)by random double-blind.The T group was given ketorolac tromethamine 30 mg(1 mL)by intravenous drip into the pot at preoperative 30 min,while 1 mL 0.9%normal saline was given in the S group.The two groups were given maintenance anesthesia of propofol and remifentanil during the conventional venous induction laryngeal mask catheter intubation general anesthesia.The patient-controlled intravenous analgesia(PCIA)pump 100 mL was given instantly after the operation end.The medication ratio of PCIA venous pump in the T group was sufentanil 1.0μg/kg+ketorolac tromethamine 3.0 mg/kg+palonosetron hydrochloride 0.25 mg,which in the S group was sufentanil 2.0μg/kg+palonosetron hydrochloride 0.25mg.The two groups set the loading dose 5 mL,background dose 2mL/h,time-locked 15 min and self-controlled dose 2 mL.The QOR40 scores before operation,on postoperative 1,2 d and the sub-indexes such as the emotion status,pain feeling,self-care ability,mental support and body comfort were observed and recorded.The satisfaction degree,hospitalization time,pressing times of analgesia pump,number of analgesic remedies and times of antemetic remedies were recorded.Results The QOR40 score in the T group was higher than that in the S group(P<0.05).Among the 5 QOR40 sub-indexes,the score of emotional state index on postoperative 1,2 d in the T group was higher than that in the S group(P<0.05);the body comfort on postoperative 1 d in the T group was higher than that in the S group(P<0.05);the hospitalization satisfaction in the T group was higher than that in the S group,while the times of antemetic remedies were less than those in the S group(P<0.05).Conclusion Applying ketorolac tromethamine during perioperative period in the patients with laparoscopic uterine myomectomy can significantly improve the postoperative the QOR40 score,reduces the complications and has an active clinical significance for early rehabilitation.