超前多模式镇痛在腹腔镜结肠肿瘤手术中的应用

目的探讨联合应用罗哌卡因局部区域阻滞和帕瑞昔布钠的超前多模式镇痛治疗在腹腔镜结肠肿瘤手术中的应用。方法 60例行腹腔镜结肠肿瘤手术的患者,随机分入对照组(A组,n=20)、罗哌卡因阻滞组(B组,n=20)及罗哌卡因阻滞+帕瑞昔布钠组(C组,n=20)。记录各组患者术后各时间点视觉模拟评分(VAS);拔管即刻和拔管后5 min躁动及镇静评分;术后镇痛舒芬太尼剂量、PCA有效按压次数;术后不良反应及切口愈合情况。测定各组患者麻醉诱导前(T1)、手术结束即刻(T2)、术后4 h(T3)及24 h(T4)的PGE2和Cor浓度。应用SPSS17.0软件处理数据。以上资料用(x珋±s)表示,组内比较采用重复测量的方差分析,组内两两比较采用S-N-K法,P0.05差异有显著意义。结果术后各时点VAS评分B、C组低于A组,C组低于B组,P0.05。C组拔管即刻、拔管后5 min躁动评分低于A组,镇静评分高于A组,P0.05。术后镇痛舒芬太尼剂量C组少于A组,PCA有效按压次数B、C组少于A组,C组少于B组,P0.05。血浆PGE2值:三组患者T1比较无显著差异P0.05,T2~T4时与T1比较升高,P0.05;C组T2~T4时低于A、B组同时点,P0.05。血清Cor值:A、B组T2-T4及C组T2、T3与T1比较升高,P0.05;C组T4与T1比较无显著差异,P0.05;T2~T4时点B、C组低于A组,C组低于B组,P0.05。各组患者术后不良反应发生率及切口愈合情况无显著差异,P0.05。结论联合应用罗哌卡因局部区域阻滞及帕瑞昔布钠的超前多模式镇痛能有效缓解腹腔镜结肠肿瘤手术后疼痛,减轻伤害性刺激对机体造成的应激及炎性反应。

Application of preemptive analgesia in laparoscopic colonic tumorectomy

Objective To investigate the clinical application of preemptive analgesia induced by intravenous parecoxib sodium combined with local infiltration of ropivacaine during laparoscopic colonic tumorectomy. Methods Sixty patients who underwent laparoscopic colonic tumorectomy were randomly divided into 3 groups: control group (group A, n =20), ropivacaine group (group B, n =20), and ropivacaine +parecoxib sodium group ( group C, n =20 ).Clinical data were collected , including postoperative visual analogue scale ( VAS ) at individual time point , scores of agitation and ramsay , consumption of sufentanil ,use of PCA , postoperative complications and wound healing .The concentrations of PGE2 in plasma and Cor in serum were measured at the induction of anesthesia ( T1 ) , the end of the operation (T2), 4 h (T3) and 24 h (T4) after operation.Statistical analyses were performed using the SPSS 17.0 software.The data were expressed as (mean ±SD).Comparison was made between the groups by ANOVA and S-N-K method respectively .A P value <0.05 was considered significantly different . Results VAS was significantly decreased in either group B or group C at each time point after operation compared with group A, furthermore VAS in group C was lower than that in group B (P<0.05).Agitation scores in group C were significantly decreased immediately after extubation and 5 minutes after extubation compared with group A, whereas Ramsay scores were significantly increased in group C (P <0.05). Consumption of sufentanil in group C was significantly decreased , whereas the use of PCA in group C was also significantly decreased compared with group A, and the use of PCA was lower in group C (P<0.05) than in group B .There was no significant difference between the 3 groups in terms of PGE 2 in plasma at T1 (P>0.05).However, PGE2 was significantly increased from T2 to T4 in the 3 groups (P<0.05).PGE2 was significantly decreased in group C at T2-T4 compared with groups A and B (P<0.05).Compared with T1, Cor in serum was significantly increased from T2 to T4 in groups A and B (P<0.05), whereas Cor was significantly increased from T2 to T3 in group C ( P <0.05).There was no significant difference in Cor between T4 and T1 in group C (P>0.05).Cor was significantly decreased from T2 to T4 in groups B and C compared with group A, whereas Cor in group C was much lower than that in group B (P<0.05).There was no significant difference in postoperative complications and wound healing among the 3 groups ( P >0.05). Conclusion For patients who receive laparoscopic colonic tumorectomy , the preemptive analgesia induced by intravenous parecoxib sodium combined with local infiltration of ropivacaine could effectively relieve postoperative pain and decrease stress and inflammatory response .