摘要
目的总结颅内肿瘤切除术患者的术后镇痛效果、术后不良反应和并发症的影响因素。方法收集2015年1月至2018年2月首都医科大学宣武医院行颅内肿瘤切除术并采用患者自控静脉镇痛(patient controlled intravenous an⁃algesia,PCIA)的476例患者的临床资料,包括手术切口位置、肿瘤病理类型、是否应用切口局部麻醉浸润等,观察患者术后24、48 h的视觉模拟评分(visual analogue score,VAS)、精神状态(Ramsay评分)、美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级、不良反应及术后神经系统并发症。比较不同切口部位、术后加用切口局部麻醉浸润对术后疼痛的影响。分析术后神经系统并发症的影响因素。结果本研究最常见的颅内肿瘤是脑膜瘤、胶质瘤和神经鞘瘤。术后恶心呕吐是最常见的不良反应(43.3%),女性发生率显著高于男性(P=0.029)。术后加用0.5%罗哌卡因切口局部浸润的患者术后6 h静息状态和活动状态的VAS显著低于对照组(P=0.005,P=0.002)。额顶叶切口术后24 h静息状态VAS高于枕叶和额颞叶切口(P=0.010)。术后神经系统并发症发生率为9.0%,与ASA分级有关。结论术后加用切口局部麻醉浸润可有效降低颅内肿瘤切除术术后疼痛。女性恶心呕吐发生率较高。术后神经系统并发症的发生率与患者ASA分级有关。
Objective To analyze the influencing factors of postoperative pain,postoperative adverse reactions and complications.Methods The medical records of patients,who underwent intracranial tumor resection in Xuanwu Hospital,Capital Medical University between January 2015 and February 2018,were reviewed retrospectively,including surgical incision,tumor pathology,incision local anesthesia.Visual analog score(VAS)and Ramsay score were compared separately both in the rest and motion status after surgery.Adverse reactions and neurological complications were recorded and evaluated.Re⁃sults Meningioma,glioma and schwannoma were the most common intracranial tumor types involved in the study.Postoperative nausea and vomiting(PONV)were the most common adverse reactions(43.3%)and the incidence was significantly higher in the females than in the males(P=0.029).The patients subcutaneously injected with 0.5%ropivacaine had a lower pain level than the control group in the rest and motion state at 5 h postoperative(P=0.005,P=0.002).The VAS of the frontoparietal group was higher at 24 h postoperative at rest(P=0.01).The incidence of postoperative neurological complications was 9.0%and primarily associated with American Society of Anesthesiologists(ASA)grades.Conclusions Ropivacaineincision local anesthesia can significantly reduce the severity of pain for patients undergoing selective intracranial tumor resection.Gender is the risk factor of PONV.The incidence of postoperative neurological complications is related to ASA grades.
作者
孙渊
王天龙
孙学丽
Sun Yuan;Wang Tianlong;Sun Xueli(Department of Anesthesiology and Operating Theater,Xuanwu Hospital,Capital Medical University,National Center for Clinical Research on Geriatric Diseases,Beijing 100053,China)
出处
《北京医学》
CAS
2020年第7期636-638,642,共4页
Beijing Medical Journal
基金
北京市医院管理局临床医学发展专项——“扬帆”计划(ZYLX201818)。
关键词
术后镇痛
颅内肿瘤切除术
analgesia
intracranial tumor resection
