摘要
目的观察开腹肝切除术后使用罗哌卡因持续切口浸润麻醉的镇痛疗效、安全性以及对肝功能的影响。方法采用前瞻性随机对照方法，将2011年5月至2012年12月在浙江大学附属邵逸夫医院普外二科60例行开腹肝切除术的患者随机数字法随机分成2组：生理盐水持续浸润组（标准对照组30例）和罗哌卡因泵持续切口浸润麻醉组（罗哌卡因组30例），同时所有患者均使用舒芬太尼静脉麻醉自控泵，记录48h内每8小时视觉模拟评分法（VAS）疼痛评分和镇静评分、48h累计舒芬太尼使用量、患者肠道功能恢复时间（以进食流质为标志）和术后住院时间，观察术后恶心呕吐情况、术前与术后3d肝功能变化情况以及有无切口感染等并发症。使用SPSS18．0统计软件进行数据统计分析。结果罗哌卡因组相比标准对照组术后镇痛效果更佳（均P〈0．05）；舒芬太尼耗量少[（43．8±21．8）比（78．2±35．2）μg，P〈0．01]；肠道功能恢复时间短[（1．2±0．4）比（1．5±0．5）d，P〈0．01]；平均住院时间短[（6．1±2．6）比（7．6±2．9）d，P〈0．05]，患者更清醒且对肝功能影响小，结果差异有统计学意义。两组均无切口感染发生。结论罗哌卡因泵持续切口浸润麻醉是一种安全有效的术后止痛方法，能加速患者术后恢复，减少住院时间，对肝功能的影响小，可作为开腹肝切除术安全有效的首选镇痛方法。
Objective To evaluate the efficacy of continuous wound infusion of ropivacaine for postoperative pain relief after open hepatectomy. Methods From May 2011 to December 2012, 60 patients undergoing open hepatectomy were randomized into normal saline continuous infusion group （ n = 30） and 0. 3% ropivacaine continuous infusion group （n = 30）. The following variables were recorded for the 48 hours postoperatively ： pain scores at rest and sedation score every 8 hours, total sufentanil consumption, first postoperative bowel movement, length of hospitalization, nausea and vomiting score, liver function change and other adverse events were also recorded. Results Pain scores at rest were lower for the ropivacaine group and reached significance after 8 h （ all P 〈 0. 05 ）. The values of snfentanil consumption [（43.8±21.8）比（78.2±35.2）μg,P〈0.01], time to bowel recovery （（1.2±0.4） vs （1.5±0.5） days, P〈 0.01） and mean length of hospitalization （（6.1±2.6） vs （7.6±2.9） days, P 〈0.05） decreased significantly. Sedation score and liver function recovery were better in ropivacaine group. No surgical wound infection occurred in either group. Conclusion Surgical wound infusion with ropivacaine is safe and effective. And it improves postoperative pain relief and accelerates patients recovery and discharge with less damage to liver function.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2013年第34期2723-2726,共4页
National Medical Journal of China
关键词
肝切除术
疼痛
手术后
罗哌卡因
持续切口浸润
Hepatectomy
Pain, postoperative
Ropivacaine
Continuous wound infiltration
