罗哌卡因胆囊三角区局部浸润对腹腔镜胆囊切除术患者苏醒期躁动及术后疼痛的影响

Effect of local infiltration of ropivacaine in gallbladder triangle on agitation and postoperative pain in patients undergoing laparoscopic cholecystectomy

目的研究罗哌卡因胆囊三角区局部浸润对腹腔镜胆囊切除术(LC)患者苏醒期躁动及术后疼痛的影响。方法选取2018年3月至2021年3月云南省肿瘤医院收治的符合本研究要求的LC患者108例,随机数字表法分为两组,各54例。两组患者均在全麻下行常规LC,同时观察组进行罗哌卡因胆囊三角区局部浸润,对照组以等量生理盐水进行胆囊三角区局部浸润。比较两组患者麻醉指标、苏醒期躁动及术后疼痛等相关指标情况。结果观察组拔管、麻醉及苏醒时间与对照组比较差异无统计学意义(均P>0.05);两组静态和动态视觉模拟量表(VAS)评分均在术后6 h达最高值,之后逐渐下降,组内差异均有统计学意义(F=15.28,4.26,11.06,3.21,均P<0.05)。观察组苏醒时、术后6、12、24 h动态、静态VAS评分均低于对照组,差异有统计学意义(均P<0.05)。观察组苏醒期Riker镇静-躁动评分(SAS)、躁动发生率及术后24 h镇痛泵按压有效次数均少于对照组(均P<0.05)。观察组术后苏醒时血氧饱和度(SpO_(2))水平较对照组差异无统计学意义(P>0.05);两组术后苏醒时心率(HR)、平均动脉压(MAP)水平均较麻醉前明显升高,观察组的上升程度明显低于对照组(均P<0.05);两组术后苏醒时去甲肾上腺素(NE)、C反应蛋白(CRP)、皮质醇水平均较麻醉前明显升高,观察组上升程度明显低于对照组(均P<0.05)。结论LC术中行罗哌卡因胆囊三角区局部浸润,能够减轻患者术后疼痛程度,减少镇痛泵的使用次数及苏醒期躁动的发生,从而维持血流动力学稳定。

Objective To study the effect of local infiltration of ropivacaine in gallbladder triangle on agitation and postoperative pain in patients undergoing laparoscopic cholecystectomy(LC).Methods 108 patients with LC who met the requirements of this study treated in Yunnan Cancer Hospital from March 2018 to March 2021 were randomly divided into two groups,54 cases in each group.Both groups received routine LC under general anesthesia.The observation group received ropivacaine for local infiltration in the gallbladder triangle,and the control group received the same amount of normal saline for local infiltration in the gallbladder triangle.The anesthesia indexes,agitation during awakening and postoperative pain were compared between the two groups.Results There was no significant difference in extubation,anesthesia and recovery time between the observation group and the control group(all P>0.05);The scores of static and dynamic visual analogue scale(VAS)in the two groups reached the highest value at 6 h after operation,and then decreased gradually,with significant differences between the two groups(F=15.28,4.26,11.06,3.21,all P<0.05).The dynamic and static VAS scores of the observation group were lower than those of the control group at the time of awakening,6 h,12 h and 24 h after operation,with statistically significant difference(all P<0.05).Compared with the control group,the Riker sedation agitation score(SAS)and the incidence of agitation in the observation group were significantly lower(all P<0.05),and the effective times of analgesic pump pressing 24 hours after operation were significantly less(P<0.05);There was no significant difference in SpO_(2) level between the observation group and the control group(P>0.05);The levels of heart rate(HR)and mean arterial pressure(MAP)in the two groups were significantly higher than those before anesthesia,and the rising degree in the observation group was significantly lower than that in the control group(all P<0.05);The levels of norepinephrine(NE),C-reactive protein(CRP)and cortisol in the two groups were significantly higher than those before anesthesia,and the rising degree in the observation group was significantly lower than that in the control group(all P<0.05).Conclusions Local infiltration of gallbladder triangle with ropivacaine during LC can reduce the degree of postoperative pain,the use of PCIA pump and the occurrence of agitation during awakening,so as to maintain hemodynamic stability.