右半结肠切除术后切口持续灌注罗哌卡因应用效果的临床观察

目的 观察切口持续灌注罗哌卡因联合静脉注射帕瑞昔布钠在右半结肠切除术后镇痛中的应用效果。方法 选取2014 年2 月-2015 年10 月锦州医科大学沈阳军区总医院收治的行右半结肠切除术的60 例患者,随机分为观察组与对照组,每组30 例。观察组术后采用切口持续灌注罗哌卡因联合静脉注射帕瑞昔布钠镇痛,对照组术后采用静脉注射帕瑞昔布钠镇痛。比较两组患者术后6、20、32、44 和56 h 的疼痛评分（NRS评分）,术后第1 天、第2 天和第3 天晨起体温,术后第1 天和第3 天白细胞计数及中性粒细胞百分数,以及术后首次排气时间、术后住院时间、切口及总的并发症发生率等。结果 观察组术后6、20、32、44 和56 hNRS 评分优于对照组（P <0.05）。两组患者术后白细胞计数和中性粒细胞百分数,术后体温及术后住院天数差异均无统计学意义（P >0.05）,但观察组术后补救镇痛人数大于对照组（P <0.05）,术后首次排气时间较对照组提前（P <0.05）。观察组术后切口并发症的发生率与对照组差异无统计学意义（P >0.05）,但总的并发症发生率低于对照组（P <0.05）。结论 切口持续灌注罗哌卡因联合静脉注射帕瑞昔布钠与单纯静脉注射帕瑞昔布钠相比,可更有效地缓解右半结肠切除患者术后疼痛,促进胃肠功能恢复,减少患者术后恶心和总的并发症的发生率。

Clinical observation of application effect of continuous woundinfusion of Ropivacaine in abdominal incision after righthemicolectomy

Objective To observe the application effect of continuous wound infusion of Ropivacainecombined with intravenous Parecoxib Sodium after right hemicolectomy. Methods Sixty patients undergoingright hemicolectomy were enrolled in our hospital from February 2014 to October 2015 and randomly divided intoobservation group (n = 30) and control group (n = 30). The observation group received analgesia with continuousincision infusion of Ropivacaine combined with intravenous Parecoxib Sodium, the control group merely receivedanalgesia with intravenous Parecoxib Sodium. The numerical rating scales (NRS) of pain at 6, 20, 32, 44 and 56h after operation, body temperature on postoperative day (POD)1, POD2 and POD3, white blood cell count andneutrophilic percentage on POD1 and POD 3, time of the first flatus, hospital stay after operation, and the incidencesof incision complications and total complications were compared between the two groups. Results NRS of pain in the observation group was significantly lower than that in the control group at 6, 20, 32, 44 and 56 h after operation (P < 0.05). Body temperature, white blood cell count, neutrophilic percentage and time of hospital stay were similar in the two groups (P > 0.05), but the number of patients requiring remedial analgesia was larger than that in the control group (P < 0.05), the time of the first flatus was significantly earlier than that in the control group (P < 0.05). The incidence of incison complications was similar in the two groups (P > 0.05), but the incidences of nausea and total complications were significantly lower than those in the control group (P < 0.05). Conclusions Compared to solely intravenous Parecoxib Sodium, continuous incision infusion of Ropivacaine combined with intravenous Parecoxib Sodium could effectively reduce pain after right hemicolectomy, promote the recovery of gastrointestinal function and decrease the occurrence of nause and total complications after operation.