腹横筋膜阻滞对腹腔镜结直肠癌根治术术后镇痛及患者恢复情况的影响(1)
[摘要] 目的 分析腹横筋膜阻滞术后镇痛效果极其对患者恢复情况的影响。方法 2016年3月—2018年4月，队列分组，对照组、观察组各方便选取腹腔镜结直肠癌根治术患者30例，术后自控镇痛泵镇痛，观察组联合腹横筋膜阻滞。对比镇痛效用指标、不良事件发生情况。结果 观察组术后第1次按自控镇痛泵的时间，术后48 h内按压自控镇痛泵次数，术后48 h内疼痛VAS评分峰值分别为(5.3±1.5)h、(15.6±4.4)次/人、(4.3±1.2)分、与对照组(2.4±0.3)h、(20.5±3.4)次/人、(5.9±1.5)分比较，差异有统计学意义(t=10.384、4.827、4.562，P=0.000、0.000、0.000<0.05);观察组不良反应发生率3.3%低于对照组26.7%，差异有统计学意义(χ2=4.706、P=0.030<0.05)。结论 腹横筋膜阻滞可以提升术后镇痛质量。
[关键词] 腹腔镜;结直肠癌根治术;术后镇痛;腹横筋膜阻滞
[中图分类号] R5 [文献标识码] A [文章编号] 1674-0742(2018)12(c)-0063-03
[Abstract] Objective To analyze the effect of fascia trans versalis block on the postoperative analgesia and recovery of patients after the laparoscopic radical resection of colorectal cancer. Methods 60 cases of patients with laparoscopic radical resection of colorectal cancer admitted and treated in our hospital from March 2016 to April 2018 were convenient selected and divided into two groups with 30 cases in each， and they were given the postoperative patient-controlled analgesia， and the observation group used the fascia trans versalis block， and the analgesia efficacy index and occurrence of adverse events were compared. Results The first time to press the patient-controlled analgesia pump， frequency of pressing the patient-controlled analgesia pump in 48h after surgery， and the pain VAS score peak value in 48h after surgery in the observation group were lower than those in the control group[(5.3±1.5) h， (15.6±4.4)times/person， ( 4.3±1.2)points vs (2.4±0.3) h， (20.5±3.4)times/person，( 5.9±1.5)points]， and the differences were statistically significant ( t=10.384， 4.827， 4.562， P=0.000， 0.000， 0.000<0.05) ， and the incidence rate of adverse reactions in the observation group was lower than that in the control group (3.3% vs 26.7%)， and the difference was statistically significant(χ2=4.706， P=0.030< 0.05) . Conclusion The fascia trans versalis block can improve the postoperative analgesia quality.
[Key words]Laparoscopic; Radical resection of colorectal cancer; Postoperative analgesia; Fascia trans versalis block
腹腔鏡结直肠癌根治术是治疗结直肠癌的首选方法，近年来因结直肠癌发病率上升、癌症筛查与诊断技术的进步，手术开展例数快速上升[1]。术后镇痛是结直肠癌根治术后管理的重要组成部分，镇痛的质量直接影响患者的术后恢复。目前针对腹腔手术术后镇痛的方法主要包括局部浸润麻醉、区域神经阻滞、自控泵镇痛等，其中镇痛泵不良反应发生率较高，区域神经阻滞越来越受到重视。该文尝试采用对照研究。选择2016年3月—2018年4月该医院肿瘤外科收治腹腔镜结直肠癌根治术患者60例入组，分析腹横筋膜阻滞术后镇痛效果极其对患者恢复情况的影响，现报道如下。
1 资料与方法
1.1 一般资料
方便选择该医院肿瘤外科收治腹腔镜结直肠癌根治术60例患者进行研究。纳入标准：①择期手术;②腹腔镜结直肠癌根治术;③美国麻醉医师协会(ASA)分级Ⅰ～Ⅲ级;④年龄40～65岁;⑤身高体重指数(BMI)18～30 kg/m2;⑥知情同意。排除标准：①合并凝血功能障碍;②滥用药物史;③慢性疼痛长期服用镇痛药物;④对实验用的药物过敏;⑤甲状腺功能障碍、认知精神障碍。退出标准：①术中腹腔镜改为开腹手术;②术中严重的并发症，如严重的心律失常;③术中知晓;④术后出现苏醒延迟、谵妄。入选对象60例，每入选1例符合纳入、排除标准的对象，便随即队列分组。对照组30例，其中男26例、女4例，年龄(59.4±8.4)岁。结肠癌20例，直肠癌10例。BMI(21.4±2.1)kg/m2。观察组30例，其中男25例、女5例，年龄(59.0±7.6)岁。结肠癌21例，直肠癌9例。BMI(21.0±2.6)kg/m2。两组对象年龄、性别、肿瘤类型、BMI水平差异无统计学意义(P>0.05), 百拇医药(谢秋红)
[关键词] 腹腔镜;结直肠癌根治术;术后镇痛;腹横筋膜阻滞
[中图分类号] R5 [文献标识码] A [文章编号] 1674-0742(2018)12(c)-0063-03
[Abstract] Objective To analyze the effect of fascia trans versalis block on the postoperative analgesia and recovery of patients after the laparoscopic radical resection of colorectal cancer. Methods 60 cases of patients with laparoscopic radical resection of colorectal cancer admitted and treated in our hospital from March 2016 to April 2018 were convenient selected and divided into two groups with 30 cases in each， and they were given the postoperative patient-controlled analgesia， and the observation group used the fascia trans versalis block， and the analgesia efficacy index and occurrence of adverse events were compared. Results The first time to press the patient-controlled analgesia pump， frequency of pressing the patient-controlled analgesia pump in 48h after surgery， and the pain VAS score peak value in 48h after surgery in the observation group were lower than those in the control group[(5.3±1.5) h， (15.6±4.4)times/person， ( 4.3±1.2)points vs (2.4±0.3) h， (20.5±3.4)times/person，( 5.9±1.5)points]， and the differences were statistically significant ( t=10.384， 4.827， 4.562， P=0.000， 0.000， 0.000<0.05) ， and the incidence rate of adverse reactions in the observation group was lower than that in the control group (3.3% vs 26.7%)， and the difference was statistically significant(χ2=4.706， P=0.030< 0.05) . Conclusion The fascia trans versalis block can improve the postoperative analgesia quality.
[Key words]Laparoscopic; Radical resection of colorectal cancer; Postoperative analgesia; Fascia trans versalis block
腹腔鏡结直肠癌根治术是治疗结直肠癌的首选方法，近年来因结直肠癌发病率上升、癌症筛查与诊断技术的进步，手术开展例数快速上升[1]。术后镇痛是结直肠癌根治术后管理的重要组成部分，镇痛的质量直接影响患者的术后恢复。目前针对腹腔手术术后镇痛的方法主要包括局部浸润麻醉、区域神经阻滞、自控泵镇痛等，其中镇痛泵不良反应发生率较高，区域神经阻滞越来越受到重视。该文尝试采用对照研究。选择2016年3月—2018年4月该医院肿瘤外科收治腹腔镜结直肠癌根治术患者60例入组，分析腹横筋膜阻滞术后镇痛效果极其对患者恢复情况的影响，现报道如下。
1 资料与方法
1.1 一般资料
方便选择该医院肿瘤外科收治腹腔镜结直肠癌根治术60例患者进行研究。纳入标准：①择期手术;②腹腔镜结直肠癌根治术;③美国麻醉医师协会(ASA)分级Ⅰ～Ⅲ级;④年龄40～65岁;⑤身高体重指数(BMI)18～30 kg/m2;⑥知情同意。排除标准：①合并凝血功能障碍;②滥用药物史;③慢性疼痛长期服用镇痛药物;④对实验用的药物过敏;⑤甲状腺功能障碍、认知精神障碍。退出标准：①术中腹腔镜改为开腹手术;②术中严重的并发症，如严重的心律失常;③术中知晓;④术后出现苏醒延迟、谵妄。入选对象60例，每入选1例符合纳入、排除标准的对象，便随即队列分组。对照组30例，其中男26例、女4例，年龄(59.4±8.4)岁。结肠癌20例，直肠癌10例。BMI(21.4±2.1)kg/m2。观察组30例，其中男25例、女5例，年龄(59.0±7.6)岁。结肠癌21例，直肠癌9例。BMI(21.0±2.6)kg/m2。两组对象年龄、性别、肿瘤类型、BMI水平差异无统计学意义(P>0.05), 百拇医药(谢秋红)