罗哌卡因-帕瑞昔布钠多模式镇痛在输卵管性不孕患者宫腹腔镜术后镇痛中的应用

目的:分析罗哌卡因联合帕瑞昔布钠多模式镇痛在输卵管性不孕患者宫腹腔镜术后镇痛效果。方法:选取2018年1月-2019年1月在本院妇产科行宫腹腔镜手术的输卵管性不孕患者112例,按照随机数字表法将患者分为观察组(56例)和对照组(56例),两组均在腹腔镜各切口周围注射0.5%的罗哌卡因10ml,观察组给予帕瑞昔布钠40mg静注,对照组给予相同容量的0.9%氯化钠。采用视觉模拟评分法(VAS)评估患者术后1、4、12、24、48h疼痛程度;比较拔管即刻和拔管后5min躁动评分和拉姆齐镇静评分(Ramsay),术中瑞芬太尼用量及术后静脉自控镇痛泵(PCA)按压次数;不良反应。结果:观察组术后各时间点VAS评分均低于对照组,拔管即刻和拔管后5min躁动评分(1.38±0.71分、0.74±0.48分)低于对照组(1.94±0.77分、1.43±0.45分)、镇静评分(1.86±0.55分、2.65±0.72分)高于对照组(1.55±0.58分、2.14±0.64分)。术后PCA按压次数(2.75±1.48次)低于对照组(5.39±1.58次)(均P<0.05),两组术中瑞芬太尼用量及术后恶心呕吐、呼吸抑制及切口水肿、感染等不良反应总发生率(14.3%、21.4%)无差异(P>0.05)。结论:罗哌卡因联合帕瑞昔布钠多模式镇痛可有效减轻宫腹腔术后患者的疼痛状态,减少术后不良反应的发生,值得临床使用。

Application of the multimodal analgesia by ropivacaine-parecoxib sodium for postoperative analgesia of women with tubal infertility after hysteroscopy

Objective:To analyze the effect of the multimodal analgesia by ropivacaine-parecoxib sodium for postoperative analgesia of women with tubal infertility after hysteroscopy.Methods:112 patients with tubal infertility who underwent laparoscopic surgery were selected and divided into observation group(56 cases)and control group(56 cases)according to random number table method from January 2018 to January 2019.The women in both groups were injected 0.5%ropivacaine 10ml around each laparoscopic incision.The women in the observation group were given intravenous injection parecoxib sodium 40mg,and the women in the control group were given the same volume of 0.9%sodium chloride.Visual analogue scale(VAS)was used to evaluate the degree of pain of women in both groups at 1,4,12,24 and 48 hours after operation.The restlessness score and Ramsay sedation score at 5 minutes and immediately after extubation,the dosage of remifentanil during operation,and the pressing times of patient-controlled intravenous analgesia(PCA)pump after operation,and the incidence of adverse reactions of women were compared between the two groups.Results:VAS scores at different time points after extubation of women in the observation group were significant lower than those of women in the control group.The scores of restlessness immediately and 5min after extubation of women in the observation group(1.38±0.71 points and 0.74±0.48 points)were significant lower than those(1.94±0.77 points and 1.43±0.45 points)of women in the control group.The scores of Ramsay sedation immediately and 5 min after extubation of women in the observation group(1.86±0.55 points and 2.65±0.72 points)were significant higher than those(1.55±0.58 points and 2.14±0.64 points)of women in the control group.The pressing times of PCA pump after operation of women in the observation group(2.75±1.48 times)was significant lower than that(5.39±1.58 times)of women in the control group(all P<0.05).There were no significant differences in the dosage of remifentanil and the total incidence(14.3%vs.21.4%)of postoperative adverse reactions,such as nausea and vomiting,respiratory depression,incision edema,and infection of women between the two groups(P>0.05).Conclusion:Ropivacaine combined with parecoxib sodium multimodal analgesia can effectively reduce the pain state of patients after uterine and abdominal surgery,and can reduce the occurrence of postoperative adverse reaction,which is worthy of clinical popularization and application.