腹腔镜胆囊切除术3 个切口疼痛程度及切口镇痛与恶心呕吐发生率的研究

Pain degree of three different incisions and relationship between incisions local infiltration and nausea-vomiting in patients receiving LC

摘要:

目的 探讨传统腹腔镜胆囊切除术（LC）后3 个切口（剑突下、脐上、右侧腹部）的疼痛程度 及切口镇痛与术后恶心呕吐发生率的关系。方法 选择接受择期LC 的患者100 例，美国麻醉医师协会分级 （ASA）Ⅰ级，手术方式均为传统三孔法，随机分为5 个组：剑突下切口组（A 组）、脐上切口组（B 组）、右 侧腹部切口组（C 组）、全部切口组（D 组）、对照组（E 组），每组20 例。手术结束缝合切口前，A 组在剑突 下切口给予0.5% 罗哌卡因3 ml 局部全层浸润；B 组在脐上切口给予0.5% 罗哌卡因3 ml 局部全层浸润；C 组 在右侧腹部切口给予0.5% 罗哌卡因3 ml 局部全层浸润；D 组分别在全部3 个切口给予0.5% 罗哌卡因各3 ml 局部全层浸润；E 组分别在全部3 个切口给予生理盐水各3 ml 局部全层浸润。采用视觉模拟评分法（VAS）， 于患者出手术室时、术后2 h、术后4 h、术后8 h、术后16 h 和术后24 h 对患者进行VAS 疼痛评分，并且记 录各组患者在术后24 h 内发生恶心呕吐的情况。结果 各组患者一般情况比较差异无统计学意义。由列的 合计可以看出：随时间延长，患者VAS 评分逐渐下降。由行的合计可以看出：5 个组VAS 评分从低到高依次 为：A 组

Abstract:

Objective To discuss the pain degree of the three different incisions (subxiphoid, navel, right abdomen) and the relationship between incisions local infiltration and nausea-vomiting after Laparoscopic Cholecystectomy (LC). Methods 100 patients (ASA I) scheduled for elective surgery were randomly divided into 5 groups (n = 20): Subxiphoid Group (Group A), Navel Group (Group B), Right Abdomen Group (Group C), All Incisions Group (Group D) and Control Group (Group E). Before the incisions were sutured, patients in Group A, Group B and Group C received incisions local infiltration of Ropivacaine (0.5%, 3 ml) in subxiphoid, navel and right abdomen. Patients in Group D received incisions local infiltration of Ropivacaine (0.5%, 3 ml) inall the three incisions. Patients in Group E received saline with the same volume (3 ml) in all the three incisions. The Visual Analogue Scale (VAS) pain scores were recorded when the patients left the operating room, 2 hours, 4 hours, 8 hours, 16 hours and 24 hours after the operation. The circumstances of nausea-vomiting were also recorded. Results Demographic parameters were similar among groups. The VAS pain scores declined with time gone by. The VAS pain scores:Group A< Group D < Group C < Group B < Group E (F = 7.16, P = 0.000). Comparison between groups: The VAS pain scores in Group A and Group D were significantly less than these in Group C and Group B. The VAS pain scores in Group C and Group B were significantly less than these in Group E. There is a difference among all the groups about the percentages of nausea-vomiting. The percentages of Group B were significantly less than these in the other 4 Groups (χ2 = 10.39, P = 0.034). Conclusions The pain of the subxiphoid incision was the most severe pain in the patients receiving LC. Compared with the other two incisions local infiltration, subxiphoid incision local infiltration proved to be the most effective treatment in reducing the VAS pain scores in patient receiving LC. Navel incision local infiltration proved to be the most effective treatment in reducing the percentages of nausea-vomiting after LC.