三种不同术后镇痛方案应用于腹腔镜全子宫切除术的临床效果观察

Application effects of three different postoperative analgesic regimens in laparoscopic total hysterectomy

目的:比较3种不同术后镇痛方案在腹腔镜全子宫切除术中的应用效果。方法:选择择期行腹腔镜下全子宫切除术病人90例为研究对象,按照随机数字表法分为地佐辛复合曲马多组(DT组)、地佐辛复合氟比洛芬酯组(DF组)、地佐辛复合舒芬太尼组(DS组),各30例。DT、DF、DS组分别采用地佐辛0.5 mg/kg+曲马多10 mg/kg、地佐辛0.5 mg/kg+氟比洛芬酯3 mg/kg、地佐辛0.5 mg/kg+舒芬太尼1μg/kg行术后静脉自控镇痛(PCIA),维持VAS评分≤3分,若VAS>3分,单次追加地佐辛0.1 mg/kg。记录病人术后2、4、8、12、24 h的Ramsay镇静评分、BCS舒适度评分;记录病人PCIA地佐辛用量、额外追加地佐辛用量、PCIA次数;记录术后肠鸣音恢复时间、首次排气时间、首次下床活动时间、恶心、呕吐、腹胀、头晕发生情况。结果:与DT、DS组比较,DF组术后肠鸣音恢复时间、首次肛门排气时间、首次下床活动时间均缩短(P<0.05),术后恶心、呕吐、腹胀及头晕发生率均降低(P<0.05)。3组病人术后2、4、8、12、24 h各时点的Ramsay镇静评分、BCS舒适度评分间差异均无统计学意义(P>0.05);3组病人PCIA的地佐辛用量、额外追加地佐辛用量、自控镇痛次数差异无统计学意义(P>0.05)。结论:地佐辛复合氟比洛芬酯在满足病人术后镇痛的基础上,更有利于胃肠功能的恢复。

Objective:To compare the clinical effects of three different postoperative analgesic regimens in laparoscopic total hysterectomy.Methods:Ninety patients scheduled by laparoscopic total hysterectomy were randomly divided into the dezocine combined with tramadol group(DT group),dezocine combined with flurbiprofen axetil group(DF group)and dezocine combined with sufentanil group(DS group)(30 cases in each group).The DT,DF and DS groups were treated with 0.5 mg/kg dezocine+10 mg/kg tramadol,0.5 mg/kg dezocine+3 mg/kg flurbiprofen axetil and 0.5 mg/kg dezocine+1μg/kg sufentanil for postoperative patient controlled intravenous analgesia(PCIA),respectively.The VAS score≤3 points was maintained.If VAS score>3 points,the 0.1 mg/kg dizocine was added in a single dose.The Ramsay sedation score and BCS comfort score among three groups were recorded after 2 h,4 h,8 h,12 h and 24 h of surgery.The dose of dezocine,dose of additional dezocine,number of PCIA,postoperative bowel sounds recovery time,first anal exhaust time,first time out of bed activity,nausea,vomiting,bloating and dizziness among three groups were recorded.Results:Compared with the DT group and DS group,the postoperative bowel sound recovery time,first anal exhaust time and first time of getting out of bed activity were significantly shortened(P<0.05),and the postoperative nausea,abdominal distension and dizziness significantly reduced in the DF group(P<0.05).There was no statistical significance in Ramsay sedation score and BCS comfort score among three groups after 2 h,4 h,8 h,12 h and 24 h of surgery,and the differences of the dose of dezocine,dose of additional dezocine and number of PCIA were not statistically significant(P>0.05).Conclusions:Dezoxin combined with flurbiprofen axetil is more beneficial to the recovery of gastrointestinal function on the basis of satisfying postoperative analgesia.