不同镇痛方式对腹腔镜胃癌根治术后加速康复的影响

Effect of different postoperative analgesic methods on fast track surgery in the patient with laparoscopic radical gastrectomy

目的 比较加速康复外科理念下不同镇痛方式对腹腔镜胃癌根治术患者术后疼痛及早期康复的影响.方法 选择2016年1月至2017年6月就诊于山西医科大学第一医院择期行腹腔镜胃癌根治术患者60例,男47例,女13例,年龄28～ 70岁,ASA分级Ⅱ或Ⅲ级,采用随机数字表法分为3组,每组20例.切口浸润联合静脉镇痛组(A组),关腹前用0.2％罗哌卡因20 ml切口逐层浸润,术后联合患者自控静脉镇痛(PCIA);硬膜外镇痛组(B组),术后单纯0.2％罗哌卡因150 ml行硬膜外患者自控镇痛(PCEA);切口浸润联合硬膜外镇痛组(C组),关腹前用0.2％罗哌卡因20 ml切口逐层浸润,之后0.15％罗哌卡因150 ml行PCEA.记录术后l、6、12、24和48 h时VAS评分,记录肠道功能恢复时间、进食时间、首次下床活动时间、住院时间,观察不良反应的发生情况.结果 B组和C组各时点VAS评分明显低于A组(P＜0.05);A组和C组肠道功能恢复时间、进食时间和下床活动时间明显早于B组(P＜0.05);3组术后不良反应发生率差异无统计学意义(P＞0.05).结论 与单纯硬膜外镇痛以及切口浸润联合静脉镇痛比较,切口浸润联合硬膜外镇痛更有利于腹腔镜胃癌根治术后患者早期下床活动,促进术后康复,较符合加速康复外科的理念.

Objective To compare the effect of different postoperative analgesic methods on fast track surgery in the patient with laparoscopic radical gastrectomy.Methods Sixty patients undergoing laparoscopic radical gastrectomy were selected from January 2016 to June 2017 in the First Hospital of Shanxi Medical University,including 47 males and 13 females,aged 28-70 years and ASA Ⅱ or Ⅲ,divided into three groups using random number table,20 cases in each group.Patients were given 0.2％ ropivacaine 20 ml for incision infiltration before closing the abdomen and postoperative patient-controlled intravenous analgesia (PCIA) in group A,0.2％ ropivacaine 150 ml for postoperative patient-controlled epidural analgesia (PCEA) in group B and 0.2％ ropivacaine 20 ml for incision infiltration before closing the abdomen and postoperative PCEA in group C.VAS was recorded at l,6,12,24,and 48 h after the surgery.Intestinal function recovery time,meal time,ambulation time of the first time,the length of hospital stay,and adverse reactions were observed and recorded.Results VAS was significantly lower in group B and C than that in group A (P ＜ 0.05).Intestinal function recovery time,meal time and ambulation time in group A and group C were significantly earlier than those in group B (P ＜ 0.05).There was no significant difference in the incidence of postoperative adverse reactions among the 3 groups.Conclusion Compared with simple epidural analgesia and incision infiltration combined with intravenous analgesia,the incision infiltration combined with epidural analgesia is more beneficial to the early ambulation and the promotion of postoperative rehabilitation in the patients with laparoscopic radical gastrectomy,which is more in line with the concept of fast track surgery.