病态肥胖患者行减重手术术后镇痛效果研究

目的比较不同类型的镇痛方式对病态肥胖患者减重手术后镇痛效果。 方法纳入自2018年9月至2019年3月于暨南大学附属第一医院行全身麻醉下腹腔镜减重手术的病态肥胖患者72例。随机分为非甾体抗炎药镇痛组（SN组），阿片类药物联合NSAIDS镇痛组（OAN组），阿片类药物镇痛组（SO组），每组各24人。手术结束前SN组80 mg帕瑞昔布钠联合60 mg酮洛酸氨丁三醇静脉推注，OAN组80 mg帕瑞昔布钠联合10~15 mg地佐辛静脉推注，SO组10~15 mg地佐辛静脉推注。记录患者手术后安返病房时（T1）、术后6 h（T2）、术后12 h（T3）、术后24 h（T4）疼痛VAS的评分、PONV评分；记录患者头晕、胸闷、瘙痒等不良反应发生情况，以及记录术后48 h患者对于镇痛治疗满意程度。 结果与SO组相比，SN、OAN组不同时间点VAS评分均显著降低（P<0.05）；SN与OAN不同时间点VAS评分之间比较无统计学意义（P>0.05）。与SN组相比，OAN组在安返病房时、术后6 h时间点PONV评分值显著升高（P<0.05）；与SN组相比，SO组在T1时间点PONV评分值显著升高（P<0.05）。三组或者在不良反应、镇痛治疗满意度调查方面均无统计学意义（P>0.05）。 结论病态肥胖患者减肥手术后仅使用非甾体抗炎药治疗，镇痛效果显著，术后恶心呕吐症状轻，可能是一种理想的镇痛方案选择。

Postoperative analgesia effect of weight loss surgery in morbid obesity patients.

ObjectiveTo compare the analgesic effect of different analgesic methods on patients with morbid obesity after weight reduction operation. Methods72 morbidly obese patients undergoing laparoscopic bariatric surgery under general anesthesia in the First Affiliated Hospital of Jinan University from September 2018 to March 2019 were included. The patients were randomly divided into non-steroidal anti-inflammatory analgesia group (SN), opioid combined NSAIDS analgesia group (OAN) and opioid analgesia group (SO), with 24 persons in each group. Before the end of the operation, 80 mg of paracyclob sodium combined with 60 mg of dizoxine intravenously in the SN group, 80 mg of paracyclob sodium combined with 10-15 mg of dizoxine intravenously in the OAN group, and 10~15 mg of dizoxine intravenously in the SO group. The pain VAS score and PONV score of patients returning safely to the ward after surgery (T1), 6 h (T2), 12 h (T3) and 24 h (T4) were recorded. The occurrence of adverse reactions such as dizziness, chest tightness and pruritus were recorded, and the satisfaction degree of the patients with analgesia treatment 48 hours after the operation was recorded. ResultsCompared with SO group, VAS scores of SN group and OAN group were significantly reduced at different time points (P<0.05). VAS scores at different time points of SN and OAN showed no statistical significance (P>0.05). Compared with SN group, PONV score of OAN group was significantly increased at the time of returning to the ward and 6h after operation (P<0.05). Compared with SN group, PONV score of SO group was significantly increased at T1 (P<0.05). There was no statistical significance in the three groups or in the satisfaction survey of adverse reactions and analgesia treatment (P>0.05). ConclusionsOnly using non-steroidal anti-inflammatory drugs after bariatric surgery in patients with morbid obesity has significant analgesic effect, and postoperative nausea and vomiting are mild, which may be an ideal analgesic option.