應(yīng)用羅哌卡因減輕腹腔鏡闌尾切除術(shù)后疼痛臨床分析

鞠雷

[摘要] 目的 探討在腹腔鏡闌尾切除術(shù)中羅哌卡因局部麻醉對減輕術(shù)后疼痛的應(yīng)用。 ?方法 于2017年3月～2018年9月在盤錦市中心醫(yī)院行腹腔鏡闌尾切除手術(shù)患者96例，隨機分成對照組和觀察組，對照組未做任何止痛處理，觀察組應(yīng)用羅哌卡因注射液于切口下局部麻醉，比較兩組術(shù)后切口的疼痛情況、下床活動情況、不良反應(yīng)等。 結(jié)果 觀察組在術(shù)后6、12、24h的疼痛評分分別為（4.3±1.0）分、（3.5±1.2）分、（3.0±1.5）分，對照組在術(shù)后6、12、24 h的疼痛評分分別為（5.2±1.1）分、（6.3±2.1）分、（6.0±1.8）分，觀察組明顯低于對照組，差異有統(tǒng)計學意義（P<0.05）。觀察組術(shù)后下床活動時間（8.7±2.3）h、排氣時間（10.7±2.1）h，對照組術(shù)后下床活動時間（11.3±2.1）h、排氣時間（12.7±2.3）h，差異有統(tǒng)計學意義（P<0.05）。在術(shù)后不良反應(yīng)上，觀察組中出現(xiàn)胃腸功能障礙3例，聯(lián)合止痛藥物治療2例，對照組中出現(xiàn)胃腸功能障礙10例，聯(lián)合止痛藥物治療9例，差異有統(tǒng)計學意義（P<0.05）。 結(jié)論 利用羅哌卡因在切口下局部麻醉可以減輕腹腔鏡闌尾切除術(shù)后切口疼痛。

[關(guān)鍵詞] 急性闌尾炎;腹腔鏡闌尾切除;羅哌卡因;術(shù)后切口疼痛

[中圖分類號] R656.8 ? ? ? ? ?[文獻標識碼] B ? ? ? ? ?[文章編號] 1673-9701（2020）12-0057-04

[Abstract] Objective To investigate the application of ropivacaine for local anesthesia during laparoscopic appendectomy to relieve postoperative pain. Methods 96 cases of laparoscopic appendectomy were performed at Panjin Central Hospital from March 2017 to September 2018. They were randomly divided into control group and observation group. The control group was not given any analgesic treatment， and the observation group was given ropivacaine injection under local anesthesia under the incision. Postoperative incision pain， off-bed activity， and adverse reactions were compared between the two groups. Results The pain scores in the observation group at 6 hours， 12 hours， and 24 hours after surgery were （4.3±1.0） points， （3.5±1.2） points， and （3.0±1.5） points. The pain scores in the control group at 6 hours， 12 hours， and 24 hours after surgery were （5.2±1.1） points， （6.3±2.1） points， and （6.0±1.8） points. The observation group was significantly lower than that in the control group， and the difference was statistically significant（P<0.05）. In the observation group， the off-bed activity time was（8.7±2.3） hours， and the exhaust time was（10.7±2.1） hours. The off-bed activity time in the control group was （11.3±2.1） hours and the exhaust time was （12.7±2.3） hours. The differences were statistically significant（P<0.05）. In terms of postoperative adverse reactions， there were 3 cases of gastrointestinal dysfunction and 2 cases of combined analgesic medication in the observation group， and there were 10 cases of gastrointestinal dysfunction and 9 cases of analgesic medication in the control group. The differences were statistically significant（P<0.05）. Conclusion Local anesthesia with ropivacaine under the incision can reduce incision pain after laparoscopic appendectomy.

近些年來，圍手術(shù)期疼痛管理的目標始終是圍繞減輕患者痛苦，使其在術(shù)后能夠盡早活動，減少住院時長，讓患者滿意。圍手術(shù)期疼痛的主要原因是組織創(chuàng)傷（如手術(shù)切開、分離、燒灼）所導致的炎癥或直接的神經(jīng)損傷（如神經(jīng)的離斷、牽拉或受壓）。當組織受到創(chuàng)傷后，就會在局部釋放許多炎癥介質(zhì)，而這些炎性介質(zhì)會提高損傷周圍區(qū)域?qū)μ弁创碳さ拿舾行裕ㄍ从X過敏），也可以對非傷害性刺激錯誤地產(chǎn)生疼痛感（觸誘發(fā)痛）。……