切口皮下多孔导管联合罗哌卡因镇痛在腹腔镜胃肠手术后加速康复中的应用

Application of incision subcutaneous porous catheter combined with ropivacaine analgesia in enhanced recovery after laparoscopic gastrointestinal surgery

目的观察切口皮下多孔导管联合罗哌卡因镇痛在腹腔镜胃肠手术后加速康复中的可行性及有效性。方法回顾性分析2021年8月至2022年4月同济大学附属上海市第四人民医院140例腹腔镜胃肠手术患者的临床资料。其中,采用常规术后镇痛70例(对照组),常规术后镇痛基础上行切口皮下多孔导管联合罗哌卡因镇痛70例(观察组)。术后4、24、32、48、56和72 h评估疼痛视觉模拟评分(VAS),记录皮下置管并发症、切口感染、术后恶心呕吐、神经症状、拔管时间、患者满意度、肠功能恢复时间和住院时间。结果观察组术后4、24、32、48、56和72 h VAS均明显低于对照组[1.000(-0.250,2.250)分比1.000(-1.000,3.000)分、2.000(1.000,3.000)分比4.000(2.000,6.000)分、1.000(0.000,2.000)分比3.000(1.000,5.000)分、2.000(1.000,3.000)分比3.000(1.750,4.250)分、(1.100±0.934)分比(2.085±0.943)分和(0.985±0.842)分比(1.814±0.921)分],差异有统计学意义(P<0.05或<0.01)。观察组肠功能恢复时间和住院时间明显短于对照组[(1.743±0.557)d比(2.200±0.714)d和(8.043±1.160)d比(8.757±1.221)d],差异有统计学意义(P<0.01);两组切口感染率、术后恶心呕吐发生率、拔管时间和患者不满意率比较差异无统计学意义(P>0.05);两组均未发生皮下置管并发症和神经症状。结论腹腔镜胃肠手术患者术后行切口皮下多孔导管联合罗哌卡因镇痛安全、有效、可行。加速康复外科下的多模式镇痛可加快胃肠术后的康复,缩短术后住院时间。

Objective To investigate the feasibility and effectiveness of incision subcutaneous porous catheter combined with ropivacaine analgesia in enhanced recovery after laparoscopic gastrointestinal surgery.Methods The clinical data of 140 patients underwent gastrointestinal surgery from August 2021 to April 2022 in Shanghai Fourth People′s Hospital,School of Medicine,Tongji University were retrospectively analyzed.Among them,70 patients were given routine postoperative analgesia(control group),and 70 patients were given incision subcutaneous porous catheter combined with ropivacaine analgesia on the basis of routine postoperative analgesia(observation group).The visual analogue score(VAS)4,24,32,48,56 and 72 h after operation was evaluated;and the complications of subcutaneous catheterization,incision infection,postoperative nausea vomiting,neurological symptoms,time to extubation,patient satisfaction degree,recovery time of intestinal function and hospital stay were recorded.Results The VAS 4,24,32,48,56 and 72 h after operation in observation group was significantly lower than that in control group:1.000(-0.250,2.250)scores vs.1.000(-1.000,3.000)scores,2.000(1.000,3.000)scores vs.4.000(2.000,6.000)scores,1.000(0.000,2.000)scores vs.3.000(1.000,5.000)scores,2.000(1.000,3.000)scores vs.3.000(1.750,4.250)scores,(1.100±0.934)scores vs.(2.085±0.943)scores and(0.985±0.842)scores vs.(1.814±0.921)scores,and there was statistical difference(P<0.05 or<0.01).The recovery time of intestinal function and hospital stay in observation group were significantly shorter than that that in control group:(1.743±0.557)d vs.(2.200±0.714)d and(8.043±1.160)d vs.(8.757±1.221)d,and there were statistical difference(P<0.01);there were no statistical differences in the rate of incision infection,incidence of postoperative nausea vomiting,time to extubation and patient dissatisfaction rate between two groups(P>0.05);there were no the complications of subcutaneous catheterization and neurological symptoms in two groups.Conclusions The incision subcutaneous porous catheter combined with ropivacaine analgesia after laparoscopic gastrointestinal surgery is a safe,effective and feasible method.Multimodal analgesia under enhanced recovery after surgery can increase the postoperative recovery after gastrointestinal operations and shorten the postoperative hospital stay.