摘要
目的 探讨罗哌卡因戳孔局部浸润对完全腹腔镜下胃癌根治术高龄患者的术后镇痛效果及其术后恢复的影响.方法 对2012年1月至2013年9月厦门大学附属第一医院厦门市肿瘤中心胃肠外科接受完全腹腔镜下胃癌根治术治疗的高龄患者（≥65岁）进行前瞻性研究,患者常规麻醉诱导、麻醉维持,术毕抽取双盲实验分组卡随机将患者分为3组：罗哌卡因组（0.5％的罗哌卡因40ml行戳孔局部浸润,n=22）;氯化钠组（0.9％的氯化钠注射液40 ml行戳孔局部浸润,n=20）;空白对照组（不行戳孔局部浸润,n=19）.所有疼痛数字等级评分（NRS） ＞4分的患者,予以盐酸吗啡注射液10 mg肌注补救镇痛.术后6h开始测定并记录双盲NRS、补救镇痛的例数及不良反应,比较各组患者术后首次下床活动时间、肠功能恢复时间、并发症、平均住院日及医疗费用.结果 术后6、12、24、48 h,氯化钠组和空白对照组的NRS均高于罗哌卡因组（5.47±0.12和5.63±0.27比2.65±0.25、5.82±0.63和5.67±0.49比2.42±0.34、3.95±0.51和3.84±0.60比2.27±0.83、3.75±0.72和3.74±0.56比2.05±0.90,均P＜0.05）;氯化钠组和空白对照组盐酸吗啡注射液使用例数多于罗哌卡因组（均P ＜0.05）;术后48 h未见明显罗哌卡因不良反应.罗哌卡因组术后首次下床活动时间早于氯化钠组和空白对照组[（53±9）比（91±11）和（93±11）h,均P＜ 0.05],肠功能恢复时间则快[（80±6）比（105±9）和（109±10）h,均P＜0.05],术后平均住院日短[（10.2±1.3）比（12.6±1.3）和（12.9±1.6）d,均P＜0.05],医疗费用少[（5.7±0.5）万比（6.3±0.6）万和（6.5±0.6）万元,均P＜0.05],术后并发症发生率低[9.10％（2/22）比25.00％（5/20）和21.05％ （4/19）,均P＜0.05].结论 罗哌卡因戳孔局部浸润的术后镇痛方法简便易行,安全有效,促进术后康复,是一种可供选择的较好镇痛方法.
Objective To explore the analgesic effects and postoperative recovery of ropivacaine incision infiltration in elderly patients after total laparoscopic radical gastrectomy.Methods The clinical data were obtained prospectively from 61 elderly patients （≥65y） undergoing traditional total laparoscopic radical gastrectomy under standard general anesthesia at our department during January 2012 and September 2013.After surgery,they were randomly double-blindly divided into 3 groups：local infiltration of ropivacaine group （0.5％ ropivacaine incision infiltration,40 ml,n =22）,local infiltration of sodium chloride group （0.9％ sodium chloride injection incision infiltration,40 ml,n =20） and control group （no analgesic,n =19）.The intensity of postoperative pain was evaluated by numeric rating scale （NRS）.And 10 mg of morphine was administered intramuscularly as rescue medication when NRS exceeded 4.NRS,cases onremedy analgesia and associated side effects were observed and recorded after 6 h postoperatively.A comparative study was made for postoperative first ambulation time,intestinal function recovery time,complication incidence,postoperative hospital stay and medical expenses among three groups.Results Significant postoperative difference existed in NRS at 6,12,24,48 h among ropivacaine,sodium and control groups respectively （6 h：2.65±0.25 vs 5.47 ±0.12 vs 5.63±0.27,12 h：2.42 ±0.34 vs 5.82±0.63 vs 5.67 ±0.49,24 h：2.27 ±0.83 vs 3.95 ±0.51 vs 3.84 ±0.60,48 h：2.05 ±0.90 vs 3.75 ±0.72 vs 3.74 ± 0.56,P ＜ 0.05）.The patients with ropivacaine local infiltration had a lower rate of remedy analgesia than those with sodium chloride injection incision infiltration or without analgesic （both P ＜ 0.05）.There was no obvious adverse effect of ropivacaine infiltration at 48 h postoperatively.Both postoperative first ambulation and peristalsis recovery time were shorter （P ＜ 0.05） in ropivacaine group （（53 ± 9） and （80 ± 6） h） than sodium group （（91 ± 11）
出处
《中华医学杂志》
CAS
CSCD
北大核心
2014年第28期2188-2192,共5页
National Medical Journal of China
基金
卫生部科技研究项目（W2012RQ09）
福建省医学创新课题（2012-CXB-29）
厦门市科技计划项目（3502Z20134011）
关键词
酰胺类
麻醉和镇痛
老年人
腹腔镜
胃肿瘤
Amides
Anesthesia and analgesia
Aged
Laparoscopes
Stomach neoplasms
