摘要
目的探讨骶管阻滞麻醉和蛛网膜下腔阻滞麻醉对肛肠手术患者术后镇痛的效果。方法选取2019年2月至2021年10月北京市肛肠医院行择期肛肠手术患者659例,根据麻醉方式分为骶麻组(368例)和腰麻组(291例)。骶麻组采用骶管给予1%利多卡因15~20 ml+0.375%~0.5%罗哌卡因5~10 ml,总量25 ml。腰麻组采用蛛网膜下腔给予0.75%盐酸罗哌卡因7.5 mg/1 ml。比较两组术后急性疼痛的差异。结果659例患者中,男375例,女284例,年龄18~70岁,平均(42.3±12.5)岁。两组急性灼烧样疼痛、急性坠胀感和术后1个月、3个月和6个月慢性疼痛发生率的比较,差异均无统计学意义(P>0.05)。腰麻组术后急性锐痛发生率高于骶麻组(32.99%比25.00%),术后3 d静息、换药、下地和排便4种状态下的视觉模拟评分(visual analogue score,VAS)高于骶麻组[2.31(2.23,4.37)分比2.01(0.01,3.26)分,3.56(2.72,5.11)分比3.13(2.28,4.16)分,2.21(1.23,3.43)分比2.03(0.02,3.11)分,4.28(3.19,5.25)分比3.10(2.01,4.14)分],恶心、呕吐和睡眠受影响的发生率高于骶麻组(8.59%比1.63%,2.06%比0.27%,13.06%比7.61%),差异均有统计学意义(P<0.05)。结论与蛛网膜下腔阻滞麻醉比较,骶管阻滞麻醉显著降低肛肠手术患者术后急性疼痛的发生率,但不能降低术后慢性疼痛的发生率。
Objective To explore the effects of sacral block anesthesia and subarachnoid block anesthesia on postoperative pain in patients undergoing anorectal surgery.Methods A total of 659 patients undergoing elective anorectal surgery in Beijing Rectum Hospital from Feburary 2019 to October 2021 were selected,and were divided into sacral anesthesia group(368 cases)and lumbar anesthesia group(291 cases)according to the anesthesia method.15-20 ml of 1%lidocaine and 5-10 ml of 0.375%-0.5%ropivacaine were injected in the sacral anesthesia group,total amount was 25 ml.0.75%ropivacaine hydrochloride 7.5 mg/1 ml were given in the lumbar anesthesia group.The difference of postoperative acute pain was compared between the two groups.Results There were 375 males and 284 females among the 659 patients,aged from 18 to 70 years,with an average age of(42.3±12.5)years.There were no significant differences in the incidence of acute burning pain,acute heaving sensation,chronic pain at one month,three months and six months after surgery between the two groups(all P>0.05).The incidence of postoperative acute shrap pain in the lumbar anesthesia group was higher than that in the sacral anesthesia group(32.99%vs.25.00%),the four VAS score of three days after operation at rest,dressing change,going to the ground and defecation were higher than those of the sacral anesthesia group[2.31(2.23,4.37)score vs.2.01(0.01,3.26)score,3.56(2.72,5.11)score vs.3.13(2.28,4.16)score,2.21(1.23,3.43)score vs.2.03(0.02,3.11)score,4.28(3.19,5.25)score vs.3.10(2.01,4.14)score],the incidence of nausea,vomiting and sleep disturbance in the lumbar anesthesia group were higher than those in the sacral anesthesia group(8.59%vs.1.63%,2.06%vs.0.27%,13.06%vs.7.61%),and the differences were statistically significant(all P<0.05).Conclusions Compared with subarachnoid block anesthesia,sacral block anesthesia can significantly reduce the incidence of acute pain in patients with anorectal surgery,but difficult to reduce the incidence of chronic pain after surgery.
作者
袁建虎
张旭光
杨茜芳
杨志军
陆海宁
Yuan Jianhu;Zhang Xuguang;Yang Qianfang;Yang Zhijun;Lu Haining(Departmentof Anesthesiology,Beijing Rectum Hospital(Beijing Erlonglu Hospital),Beijing 100120,China)
出处
《北京医学》
CAS
2023年第7期589-592,共4页
Beijing Medical Journal
基金
北京市肛肠医院(北京市二龙路医院)院内基金(cx20180001)。
关键词
骶管阻滞麻醉
蛛网膜下腔阻滞麻醉
疼痛
肛肠手术
急性
慢性
sacral canal block anesthesia
subarachnoid block anesthesia
pain
anorectal surgery
acute
chronic
