胸段硬膜外镇痛对腹腔镜结直肠手术后疼痛的影响及护理观察

摘要

目的 本研究旨在探讨胸段硬膜外镇痛对腹腔镜结直肠手术后疼痛的影响及护理体会.方法 将采用相同围术期处理的腹腔镜结直肠手术患者50例随机分为静脉镇痛(IA)组25例和胸段硬膜外镇痛(TEA)组25例,IA组采用静脉注射曲马朵自控镇痛,TEA组采用胸段硬膜外注射罗哌卡因和芬太尼自控镇痛,测定2组患者的视觉模拟评分(VAS),记录术后排气时间、口服半流饮食时间和术后住院天数,并观察记录不良反应及并发症.结果 使用硬膜外镇痛的TEA组在术后第1天、第2天的VAS显著低于IA组(P＜0.05);TEA组术后排气时间、口服半流饮食时间及术后住院天数显著短于IA组(P＜0.05);2组术后并发症及再住院率则无统计学差异(P＞0.05).结论 胸段硬膜外镇痛应用于腹腔镜结直肠手术可为患者提供有效的术后镇痛,并使患者下床活动提前,减少了卧床时间,优化了术后护理.%Objective The role of thoracic epidural anesthesia is emphasized in fast-track rehabilitation.This study is to investigates the effect of thoracic epidural analgesia on postoperative pain relief and bowel function recovery in patients underwent laparoscopic colorectal resection.Methods Fifty patients scheduled for elective laparoscopic colorectal resection were randomized to either intravenous analgesia(IA) with tramadol (n =25) or TEA with ropivacaine and fentanyl (n =25).Postoperative quality of analgesia(Visual Analogue Scale,VAS),time until passage of gas,dietary intake,length of hospital stay and readmissions were recorded.Results Intensity of pain during the first two postoperative days was significantly lower at rest,with coughing,and with walking in the TEA group (P ＜ 0.05).Recovery of postoperative ileus in the TEA group occurred sooner (P ＜ 0.05),and resumption of full diet was achieved earlier (P ＜ 0.05),length of hospital stay were obviously shorter(P ＜ 0.05) compared with IA group.Readmissions and postoperative morbidity were otherwise similar in the two groups.Conclusions TEA provides a significant benefit postoperative pain relief and faster recovery of gastrointestinal function in patients undergoing laparoscopic colorectal resection.