文章摘要
不同浓度罗哌卡因局部浸润对肝炎肝硬化患者术后切口疼痛及康复的影响
Effects of postoperative analgesia with different concentration of ropivacaine used in incision infiltration in patients with hepatitis cirrhosis in recovery after surgery
  
DOI：10.12089/jca.2018.08.008
中文关键词: 罗哌卡因  局部浸润  肝炎肝硬化  术后镇痛
英文关键词: Ropivacaine  Incision infiltration  Hepatitis cirrhosis  Postoperative analgesia
基金项目:
作者单位E-mail
张维峰 210003,南京市第二医院,东南大学附属南京市第二医院麻醉科  
殷国平 210003,南京市第二医院,东南大学附属南京市第二医院麻醉科 yinguoping0304@163.com 
王佳 210003,南京市第二医院,东南大学附属南京市第二医院麻醉科  
仲艳玲 210003,南京市第二医院,东南大学附属南京市第二医院麻醉科  
陈慧 210003,南京市第二医院,东南大学附属南京市第二医院麻醉科  
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中文摘要:
      
目的 探讨不同浓度罗哌卡因切口局部浸润对肝炎肝硬化行脾切断流术患者术后切口疼痛及康复的影响。

方法 择期行脾切除断流术的肝炎肝硬化患者60例,男38例,女22例,年龄35～65岁,ASA Ⅱ或Ⅲ级,Child-Pugh A或B级,采用随机数字表法分为三组,每组20例。三组患者分别于关腹前给予0.5%罗哌卡因10 ml(R1组)、0.375%罗哌卡因10 ml(R2组)和生理盐水10 ml(C组)行切口两侧局部浸润。三组患者术毕均给予地佐辛0.8 mg/kg+昂丹司琼8 mg行PCIA。记录术后0、2、6、12、24和48 h VAS疼痛评分,记录首次追加镇痛药物时间;记录术后6、24、48 h 镇痛泵实际按压次数和有效按压次数;记录术后首次排气排便、下床活动时间和术后住院时间;记录不良反应发生情况。

结果 与C组比较,R1、R2组术后0、2、6 h的VAS疼痛评分明显降低,首次追加镇痛泵药物时间明显延长,6 h按压次数明显减少,首次排气排便和下床活动时间明显提前,总住院时间明显缩短(P<0.05)。R1组首次追加镇痛药时间明显迟于R2组（P<0.05），其余指标两组差异无统计学意义。三组患者术后不良反应发生率差异无统计学意义。

结论 行脾切除断流手术的肝炎肝硬化患者于术毕给予0.5%或0.375%罗哌卡因行切口局部浸润,可加强术后镇痛效果,促进患者康复,且不增加不良反应。
英文摘要:
      
Objective To investigate the effectiveness and safety of wound infiltration with different concentration of ropivacaine for postoperative analgesia as a fast-track approach in patients with hepatitis cirrhosis undergoing splenectomy.

Methods Sixty patients with hepatitis cirrhosis, 38 males and 22 females, aged 35 - 65 years, ASA physical status Ⅱ or Ⅲ, Child-Pugh A or B, scheduled for elective splenectomy were randomly divided into three groups, 20 cases in each group. Group R1, group R2 and group C received incision infiltration of 0.5% ropivacaine, 0.375% ropivacaine and normal saline of 10 ml at the end of the surgery respectively. All patients received dezocine 0.8 mg/kg+ondansetron 8 mg as patient controlled intravenous analgesia (PCIA) after surgery. Visual analogue scales (VAS) was used to evaluate the analgesic effect at 0, 2, 6, 12, 24 and 48 h after surgery, the time of the first additional analgesic drugs, the press times of the PCIA pump at 6, 24 and 48 h after surgery, and the cumulative amount analgesic drug were recorded. The time to first flatus or defecation and mobilization, length of stay in hospital after surgery, and adverse events in 48 h were recorded.

Results Compared with group C, the VAS pain score was significantly decreased at 0 h, 2 h and 6 h after operation in groups R1 and R2, the time of the first additional analgesic drug was prolonged, the pressing times of PCIA pump within 6 h, the time to first flatus of defecation was shortened (P < 0.05). Compared with group R2, the time of the first additional analgesic drug was prolonged (P < 0.05). There were no significant differences in other parameters between group R1 and group R2. However, the incidence of adverse reactions in the three groups was not statistically significant.

Conclusion Incision infiltration of ropivacaine could effectively relieve post-operative pain, and could be an effective fast-track approach for patients with hepatitis cirrhosis undergoing splenectomy, and postpone the additional use of early postoperative analgesic drugs without increasing adverse reactions.
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