不同麻醉方式对复杂性肛瘘手术及术后镇痛效果观察

目的：探讨不同麻醉方式对复杂性肛瘘手术及术后镇痛效果。方法：对我院收治的132例复杂肛瘘患者随机分为三组，每组患者44例，分别为硬膜外麻醉组（EA组）、局部麻醉组（LA组）、自控镇痛联合局部麻醉组（PCA组）；比较三组患者的麻醉时间、VAS评分以及生命体征、不良反应等比较。结果：三组患者手术情况比较，LA组以及PCA组患者在麻醉操作时间以及留室观察时间明显短于EA组；VAS评分比较，在术中以及术后个时间点比较中，EA组以及PCA组患者其VAS评分均优于LA组；三组患者生命体征比较，三组患者在各时间点比较均无统计学差异性（p＞0.05）；但与本组患者麻醉前比较三组患者SBP、DBP在术中有明显的增加（p＜0.05）；三组患者不良反应比较，EA组以及PCA组患者在肛周疼痛、不良体动的发生机会明显低于LA组，而EA组其出现呕吐、尿潴留以及下肢活动受限的例数明显高于LA组；PCA组呕吐出现例数明显高于LA组，而尿潴留、下肢活动受限的出现例数明显低于EA组。结论：对于复杂肛瘘患者采用自控镇痛联合局部麻醉具有操作简单，麻醉效果理想以及并发症少等特点，值得在临床推广。

Different Anesthetic Techniques for Complex Anal Fistula Surgery and Postoperative Analgesia

Objective To investigate the different anesthetic techniques for complex anal fistula surgery and postoperative analgesia. Methods 132 hospitalized patients with complex anal fistula were randomly divided into three groups, 44 each ： Epidural anesthesia group （ EA group）, Local anesthesia group （ LA group）, and controlled analgesia in combination with local anesthesia group （PCA group）. The VAS score, vital signs, and adverse events were compared. Results The LA and PCA group patients had anesthesia time and stay in the room observation time shorter than the EA group;VAS scores during surgery and postoperative analgesia in EA and PCA group patients were better than the LA group; there was no difference in vital signs among three groups. The SBP and DBP had increased during surgery as compared to before anesthesia in all three groups. In regard to adverse reactions, EA group and PCA group patients had lower incidence of perianal pain and poor body action than the LA group. PCA group had higher incidence of vomiting than the LA group, higher urine retention than the LA and EA group, and lower extremity limit than the EA group. Conclusion For patients with complex anal fistula,the controlled analgesia combined with local, simple anesthesia can achieve satisfactory results with fewer complications, and this combination is worth of clinical practice.