联合用药镇痛在肝破裂出血肝切除术中的应用研究

Study on the application of combined analgesia in hepatectomy for liver rupture and hemorrhage

目的比较肝破裂出血急诊行肝切除术后联合用药镇痛和传统模式镇痛对镇痛效果、术后恢复情况及相关并发症的影响。方法选取50例肝破裂出血急诊行肝切除术后患者为研究对象,分为联合用药镇痛组和传统模式镇痛组,每组25例。联合用药镇痛组术后静脉留置自控镇痛(PCA)泵(地佐辛20 mg)+帕瑞昔布钠40 mg静脉注射+按需口服镇痛药;传统模式镇痛组术后仅用PCA泵。比较两组患者术后的视觉模拟评分法(VAS)评分、恢复情况和术后10 d相关并发症发生率。结果联合用药镇痛组术日晚21点及术后1、2、3和4 d VAS评分分别为(4.7±0.8)、(4.2±0.9)、(2.8±0.7)、(2.6±0.6)和(1.6±0.6)分,明显低于传统模式镇痛组的(5.8±0.8)、(5.0±0.6)、(3.8±0.7)、(3.0±0.5)和(2.5±0.6)分(P<0.05)。联合用药镇痛组术后首次离床时间、首次排气时间、首次排便时间、首次流质时间均明显早于传统模式镇痛组(P<0.05)。两组患者术后10 d均未发生并发症。结论联合用药镇痛可明显降低肝破裂出血急诊行肝切除手术患者术后疼痛的主观感受。

Objective Compare the effects of combined analgesia and traditional mode analgesia on the analgesic efficacy,postoperative recovery and related complications after emergency liver resection for hepatic rupture and hemorrhage.Methods Fifty patients with liver resection who underwent hepatectomy for emergency liver rupture were selected and divided into the combined analgesia group and the traditional analgesia group,with 25 cases in each group.The combined analgesia group was treated by controlled analgesia pump(PCA)with 20 mg dezocine+40 mg parecoxib sodium intravenous injection+oral analgesics on demand,while the traditional analgesia group was treated by PCA with 20 mg dezocine only.The postoperative visual analogue scoring(VAS)score,recovery and the incidence of postoperative complications were compared between the two groups.Results The postoperative VAS score of 9 pm on the operative day and 1,2,3 and 4 d after the operative day was(4.7±0.8),(4.2±0.9),(2.8±0.7),(2.6±0.6)and(1.6±0.6)points,respectively,and all of these were significantly lower than those of the traditional analgesia group,which was(5.8±0.8),(5.0±0.6),(3.8±0.7),(3.0±0.5)and(2.5±0.6)points,respectively(P<0.05).The first time to out of the bed,exhaust,defecate and eating fluid in the combined analgesia group were significantly earlier than those in the traditional analgesia group(P<0.05).There were no complications in the two groups 10 days after operation.Conclusion Combined analgesia could reduce the subjective experience of postoperative pain in patients undergoing emergent hepatectomy.