复方亚甲蓝溶液与持续硬膜外镇痛泵在重度痔术后临床镇痛效果的比较分析

Efficacy of methylene blue versus continuous epidural analgesia pump for pain con⁃trol after surgery for severe hemorrhoids

目的比较复方亚甲蓝溶液与持续硬膜外镇痛泵在重度痔手术后的镇痛效果。方法纳入揭阳市人民医院2018年4月至2019年6月收治的83例行PPH术+痔切除术治疗的重度混合痔(Ⅲ~Ⅳ度混合痔)患者为研究对象,将入组患者随机分为治疗组(n=33,术后予复方亚甲蓝溶液镇痛)和对照组(n=50,术后予留置维持48 h的持续硬膜外镇痛泵镇痛)。比较两组患者术后6h、24 h、48 h、72 h、1周及第一次排便时的疼痛视觉模拟评分(VAS)、术后追加镇痛药物情况、不良反应的发生情况,以及患者对术后疼痛管理的满意度。结果两组术后6 h、24 h、48 h的VAS评分比较,差异均无统计学意义(均P>0.05)。治疗组在术后72 h、术后1周和第一次排便时的VAS评分较对照组低,差异均有统计学意义(均P<0.01)。治疗组术后追加止痛药共8例(24.2%),对照组共10例(20.0%),两组比较差异无统计学意义(P>0.05)。治疗组出现尿潴留共5例(15.2%),对照组出现头晕2例(4.0%),恶心呕吐3例(6.0%),下肢乏力2例(4.0%)。两组患者均没有出现肛周不良反应。治疗组并发症总发生率为15.2%,对照组为14%,两组相比差异无统计学意义(P>0.05)。治疗组和对照组对住院期间疼痛管理的满意度分别为87.9%和84.0%,两组相比,差异无统计学意义(P>0.05)。结论复方亚甲蓝溶液与持续硬膜外镇痛泵在重度痔术后的镇痛效果相近,但前者有长效镇痛效果的优势,且并不增加术后不良反应发生率,可有效避免硬膜外镇痛所引起的头晕、恶心呕吐、下肢乏力等不良反应,值得在临床中应用推广。

Objectives To compare the analgesic effect of methylene blue versus continuous epidural analgesia pump after sur⁃gery for severe hemorrhoids.Methods Eighty-three patients with severe mixed hemorrhoids(ⅢtoⅣdegree)treated by proce⁃dure for prolapse and hemorrhoids(PPH)and hemorrhoidectomy in Jieyang People’s Hospital between April 2018 and June 2019 were recruited.They were randomly assigned to the treatment group(n=33)and the control group(n=50).Patients in the treatment group received postoperative compound methylene blue,and those in the control group received continuous epidural anal⁃gesia pump in the first 48 hours after surgery.The followings were compared between the two groups,visual analog scale(VAS)score at 6,24,48,72 hours,one week after surgery,and at the time of the first postoperative bowel movement,additional analge⁃sics usage,the incidence of adverse events,and patients’satisfaction with postoperative pain control.Results There were no sig⁃nificant differences between the two groups in VAS score at 6,24,and 48 hours after surgery(P>0.05).The treatment group had significantly lower VAS score than the control group at 72 hours,one week after surgery,and at the time of the first postopera⁃tive bowel movement(P<0.01).Eight(24.2%)patients in the treatment group and ten(20.0%)in the control group required addi⁃tional analgesics.The percentage of additional analgesics usage did not differ between the two groups(P>0.05).Five(15.2%)pa⁃tients in the treatment group had urinary retention.In the control group,two(4.0%)patients had dizziness,three(6.0%)had nau⁃sea and vomiting,and two(4.0%)had lower limb fatigue.No patients reported perianal adverse events.The overall incidence of complications was 15.2%in the treatment group and 14%in the control group with no significant between-group differences(P>0.05).Patients’satisfaction with pain control was 87.9%in the treatment group and 84.0%in the control group with no signifi⁃cant between-group differences(P>0.05).Conclusion Compound methylene blue is comparable to that of continuous epidural an⁃algesia pump as analgesics after surgery for severe hemorrhoids.It has an advantage for long-term pain control and does not in⁃crease the risk of postoperative adverse events.It can effectively prevent adverse events commonly associated with epidural analge⁃sias such as dizziness,nausea and vomiting,and lower limb fatigue.It has the potential for broader clinical use.