纳布啡、舒芬太尼联合罗哌卡因用于妇科单孔腹腔镜术后多模式镇痛的效果观察

摘要

目的 观察纳布啡、舒芬太尼联合罗哌卡因局部浸润多模式镇痛应用于妇科单孔腹腔镜术后镇痛的效果.方法 择期104例静脉复合麻醉下行经脐妇科单孔腹腔镜手术的患者,按完全随机分组法分为A、B两组(每组52例),A组采用舒芬太尼0.04μg/(kg·h),术后持续48 h泵注行自控静脉镇痛;B组在缝合伤口前用0.5％盐酸罗哌卡因10 ml行切口周围局部浸润,术毕采用舒芬太尼0.03μg/(kg·h)加纳布啡15μg/(kg·h),术后持续48 h泵注行自控静脉镇痛.观察记录妇科患者在腹腔镜手术后0～2h、2～6h、6～ 12h、12～24 h、24～48h时间段的镇痛、镇静及舒适评分,两组患者术后48 h内镇痛相关副反应发生例数,比较PCIA需自控按压次数及单孔腹腔镜手术切口部位舒适满意度.结果 B组在腔镜手术后12 h内各时间段按压次数较A组显著减少(P＜0.05),B组出恢复室后2h、6h时间点的VAS镇痛评分显著低于A组(P＜0.05),B组出恢复室后各时间段BCS舒适评分明显高于A组(P＜0.05).两组女性患者对单孔腹腔镜手术切口部位舒适满意度评估B组明显优于A组(P＜0.05),镇痛相关的恶心、呕吐的发生例数B组明显低于A组(P＜ 0.05).结论 纳布啡、舒芬太尼联合罗哌卡因局部浸润的多模式镇痛应用于妇科单孔腹腔镜术后,可显著提高术后镇痛效果、减少不良反应发生,同时增强了术后单孔手术切口的舒适满意度,为特定患者的快速康复提供了一个新的思路.%Objective To observe the analgesic effect of local infiltration multimodal analgesia with nalbuphine,sufentanil,and ropivacaine in gynecological single-hole laparoscopic surgery.Methods A total of 104 patients who were treated with gynecological single-hole laparoscopic surgery under intravenous combined anesthesia were divided into group A and B according to the complete random grouping method,52 cases in each group.Group A was given postoperative patient controlled intravenous analgesia (PCIA) with 48 hours of continuous pump injection with sufentanil 0.04tg/(kg·h);group B was given local infiltration around the incision with 10 ml of 0.5％ ropivaeaine before the wound was sutured,and postoperative PCIA with 48 hours of continuous pump injection with sufentanil 0.03μg/(kg·h) and nalbuphine 15tg/(kg·h).Observed the analgesic,sedation and comfort scores of gynecological patients in the period of 0-2 h,2-6 h,6-12 h,12-24 h,and 24-48 h after laparoscopic surgery,the incidence of analgesic adverse events within 48 h after laparoscopic surgery in the two groups,the times of self-control compressions,and the comfortable satisfaction degree of the incision site of single-hole laparoscopic surgery.Results The times of self-control compressions at each time period within 12 h after laparoscopic surgery in group B were significantly less than those in group A (P＜0.05).The VAS analgesia score of group B at 2 h and 6 h after exiting the recovery room were significantly lower than those of group A (P＜0.05).The BCS comfort score of group B was significantly higher than that of group A at each time point after exiting the recovery room (P＜0.05).The comfortable satisfaction degree of the incision site of single-hole laparoscopic surgery of group B was significantly better than that of group A (P＜0.05).The incidence of analgesic nausea and vomiting of group B was significantly lower than that of group A (P＜0.05).Conclusions The multimodal analgesia with nalbuphine,sufentanil,and ropivacaine local infiltration can significantly improve the analgesic effect after gynecological single-hole laparoscopic surgery,reduce adverse reactions,enhance comfort degree of the incision site of single-hole laparoscopic surgery,which provides a new idea for the rapid recovery of specific patients.