摘要
目的探讨腹腔镜下胆囊切除术（LC）在手术前、后用长效局麻药联合氯诺昔康及地塞米松进行多模式预先镇痛能否提供更优越的镇痛效果。方法LC患者60例,随机分成A（术前用药组）、B（术后用药组）、C组（术前术后用药组）,每组20例。由1名对用药不知晓的麻醉科医生用视觉模拟疼痛评分（VAS）记录术后各时点的总疼痛程度、切口痛、内脏痛及肩部痛的疼痛评分,以及第1次应用麻醉性止痛剂的时间、剂量和使用总量。并于手术前、术后2 h抽取外周静脉血,测血糖、皮质醇浓度。结果（1）术后总疼痛程度评分,三组间有统计学差异（P〈0.05）,C组VAS显著低于B组（P〈0.05）;与B组比较,A组在术后4、8 h的VAS明显降低（P〈0.05）;术后24 h,C组和A组比较有统计学差异（P〈0.05）;（2）C组在24 h内均能发挥良好的切口镇痛效果,在术后2、4、12 h较B组能更好地缓解内脏痛（P〈0.05）,C组VAS评分在术后1、12、24 h显著低于A组（P〈0.01）,A、B组在各个时间点VAS评分比较无统计学差异（P〉0.05）;（3）血糖浓度：A、B组在局麻术后2 h增高（P〈0.05）,显著高于C组（P〈0.05）;（4）皮质醇血浆浓度B组在术后2 h即有升高（P〈0.01）,显著高于C组（P〈0.05）。结论术前术后联合用药多模式预先镇痛能较术前单独或术后联合用药止痛模式提供更完善的镇痛,对机体疼痛应激反应有更好的抑制作用。
Objective To investigate whether multimodal pre-emptive analgesia combined with lornoxicam and dexamethasone could provide much better postoperative analgesia in patients undergoing laparoscopic cholecystectomy （LC）. Methods Sixty patients undergoing LC were randomly divided into three groups： group A （preoperative medication group）, group B （postoperative treatment group） and group C （pre-and postoperative analgesia group）, （n 20 each）. The VAS of total pain, incision pain, visceral pain and radiating pain to shoulder, as well as the time of first dose and total dose of narcotics used were recorded by an anesthesiologist who was blind to the procedure. The concentration of blood glucose and cortisol before and 2 h after operation were assayed. Results （1） For the postoperative total pain scores, there was significant difference among the three groups （P〈 0.05） ; The scores were lower in group C than that in group B （P〈 0.05） ; The scores at 4 h and 8 h after operation were lower in group A than that in group B （P〈 0. 05）; There was significant difference between group C and group A at 24 h after operation （P〈 0.05）. （2） The analgesic effect on incision was excellent during 24 h in group C; The visceral pain at 2 h, 4 h and 12 h after operation could be alleviated more in group C than that in group B （P〈 0.05） ; The scores at 1 h, 12 h and 24 h after operation were significantly lower in group C than that in group A（P〈 0. 01）. （3） Blood sugar concentration increased at 2 h after operation in group A and B（P〈 0.05）, which were higher than that in group C （P〈 0.05）. （4） Plasma cortisol concentration increased at 2 h after op eration in group B （P〈0.01）, which was higher than that in group C （P〈0.05）. Conclusion Compared to preoperative or postoperative modal, the multimodal pre-emptive analgesia combined preoperative and postoperative local anesthetic could provide much better analgesia and more inhibition of stress.
出处
《实用疼痛学杂志》
2009年第4期275-278,共4页
Pain Clinic Journal
关键词
胆囊切除术
腹腔镜
氯诺昔康
甲磺酸罗哌卡因
预先镇痛
VAS
联合用药
Cholecystectomy, Laparoseopic
Lornoxicam
Ropivacaine Mesylate
Pre- emptive Analgesia
Visual Analogue Scale
Drug Combination
