预防性镇痛在肝胆管结石治疗中的临床应用

目的探索预防性镇痛在肝胆管结石治疗中的应用价值。方法将2015年1月至2016年10月湖南省人民医院肝胆外科收治的90例肝胆管结石患者随机分为观察组和对照组,每组各45例。观察组术后予静脉自控镇痛泵+术后连续3 d使用氟比洛芬酯静滴100 mg qd+术后3 d使用地佐辛注射液5 mg肌注qn。对照组仅予静脉自控镇痛泵处理,患者疼痛难忍时予肌注盐酸哌替啶。比较两组患者术后6、12、24、48、72h疼痛评分,术后首次下床活动时间,肛门排气时间、住院天数、住院费用及并发症。结果观察组术后6、12、24、48、72 h疼痛评分均低于对照组[(2.42±0.92)vs(3.16±0.71),(2.07±0.62)vs(2.44±0.76),(2.29±0.55)vs(2.82±0.61),(2.53±0.50)vs(2.77±0.52),(1.58±0.50)vs(2.44±0.59)],差异有统计学意义(P0.05)。观察组首次下床活动时间、排气时间、住院天数均短于对照组[(1.49±0.51)d vs(2.36±0.48)d,(3.2±0.66)d vs(3.6±0.65)d,(8.09±0.90)d vs(8.96±1.04)d],差异有统计学意义(P0.05)。两组患者住院费用[(5.5±1.5)万元vs(5.3±1.7)万元]及术后并发症发生率无统计学差异(P0.05)]。结论肝胆管结石术后预防性镇痛方案安全有效,可以减少患者术后疼痛,加速患者康复。

Clinical application of preventive analgesia in the treatment of hepatolithiasis

Objective To explore the value of preventive analgesia in the treatment of hepatolithiasis. Meth-ods A total of 90 patients with hepatolithiasis admitted in Hunan Provincial People's Hospital between Jan. 2015 and Oct. 2016 were randomly into Observation group and Control group (each group 50 cases). The Observation group were treated with vein self-control analgesia pump and postoperative continuous flurbiprofen axetil 100 mg qd for 3 d, and postoperative with dezocine 5 mg intramuscular injection qn for 3 d. The Control group were only offered with vein self-control analgesia pump treatment. The pain score at 6, 12, 24, 48 and 72 h postoperative, time of first ambulation, time of recovery of the anal exsufflation and complications were compared between two group. Results In the observation group, the pain score at 6, 12, 24 and 48 h postoperative were lower than those in the control group [(2.42±0.92) vs (3.16±0.71), (2.07±0.62) vs (2.44±0.76), (2.29±0.55) vs (2.82±0.61), (2.53±0.50) vs (2.77±0.52), (1.58±0.50) vs (2.44±0.59)], the difference was all statistically significant (P<0.05). The time of first ambulation [(1.49±0.51) d vs (2.36±0.48) d], the time of first exhaust [(3.2±0.66) d vs (3.6±0.65) d], duration of hospitalization [(8.09±0.90) d vs (8.96±1.04) d] in the observation group were all shorter than those in the control group, the difference were all statistically significant (P<0.05). There was no significant dif-ference on hospitalization cost [(55.0±15.0) thousand yuan vs (53.0±17.0) thousand yuan] and postoperative complications between two groups (P>0.05). Conclusion Preventive analgesia application in the treatment of hepatolithiasis is safe and effective, which may reduce pain score and accelerate patients rehabilitation.