罗哌卡因联合右美托咪啶腹腔喷洒对腹腔镜下结直肠癌手术术后疼痛的影响

摘要

目的 观察罗哌卡因联合右美托咪啶腹腔喷洒对腹腔镜下结直肠癌手术术后疼痛的影响.方法 前瞻性研究,将2016年1月至2017年8月期间拟行腹腔镜下结直肠癌手术的患者40例采用信封法随机分为罗哌卡因组(L组,n=20)和罗哌卡因联合右美托咪啶组(LY组,n=20),两组患者分别在手术结束前腹腔镜直视下腹腔内喷洒0.25％罗哌卡因50 ml(L组)和0.25％罗哌卡因和1μg/kg的右美托咪啶混合液50 ml(LY组),观察比较两组患者拔管后(T 0)、术后2 h(T 1)、术后4 h(T 2)、术后24 h(T 3)的视觉模拟疼痛评分(VAS),术后第一次辅助镇痛药物(曲马多)时间、曲马多总量和不良反应情况.结果 L组在各时间点VAS评分均高于LY组,差异具有统计学意义(P<0.05).L组术后第一次辅助镇痛药物时间[(90.75±36.10)min]明显短于LY组[(759.00±277.54)min],P<0.05.L组曲马多总用量[(222.50±86.56)mg]明显高于LY组[(77.50±54.95)mg],差异有统计学意义(P<0.05).结论 罗哌卡因联合右美托咪啶腹腔喷洒可有效降低腹腔镜下结直肠癌手术术后24 h内的VAS评分,延长术后第一次辅助镇痛药物的时间,减少辅助镇痛药物用量.%Objective To observe the effect of Ropivacaine combined with Dexmedetomidine intraperitoneal spray on postoperative pain after laparoscopic colorectal cancer surgery. Methods Forty patients underwent laparoscopic colorectal surgery from January 2016 to August 2017 were randomly divided into ropivacaine group (L group,n = 20)and ropivacaine combined with dexmedetomidine group (LY group,n = 20)used envelope method. 0. 25％ ropivacaine 50 ml (L group)and 0. 25％ ropivacaine and 1 μg/ kg dexmedetomidine mixture 50 ml (LY group)were sprayed uniformly into the peritoneal cavity guided by the camera before the end of the operation. The visual analogue scale after tracheal extubation (T0 ),postoperative 2 h (T1 ),postoperative 4 h (T2 )and postoperative 24 h (T3 )and the first time of postoperative analgesic drugs (Tramad-ol),the total dose of Tramadol and adverse reactions of two groups were compared. Results The VAS score in L group was higher than that in LY group at each time points,and the difference was statistically significant(P < 0. 05). The first time of postoperative analgesic drugs (90. 75 ± 36. 10)min in L group was significantly shorter than that in LY group (759 ± 277. 54)min,(P < 0. 05). The total dosage of Tramadol in L group (222. 50 ± 86. 56)mg was significantly higher than that of LY group (77. 50 ± 54. 95)mg,P < 0. 05. Conclusion Intraperitoneal Ropiv-acaine with Dexmedetomidine can effectively reduce the VAS score within 24 hours after laparoscopic colorectal cancer surgery,prolong the postop-erative analgesia time and reduce the dosage of postoperative analgesic drugs.