目的 探讨结直肠癌根治术患者应用普瑞巴林联合腰方肌阻滞麻醉的效果。方法 病例收集时间为2022年1-10月,解放军总医院海南医院筛选符合要求的结直肠癌根治术后患者66例,随机分为对照组,腰方肌组,普瑞巴林组,每组22例。三组患者均采用术后静脉自控镇痛治疗(PCIA),普瑞巴林组及腰方肌组患者麻醉诱导后行双侧腰方肌阻滞,普瑞巴林组患者术前共口服普瑞巴林胶囊150 mg,术前1 d晚8点及术前30 min各口服75 mg,腰方肌组及对照组患者相同时间点口服安慰剂。对比三组患者术后2、12、24、48 h各时间点的VAS评分,术中舒芬太尼及瑞芬太尼用量,术前1 d及切皮后15 min、术后24 h、48 h的血清CRP及皮质醇浓度,术前及切皮后15 min的生命体征,术后2 d不良反应,以及术后下地时间、拔除尿管时间、首次喝水时间、术后住院天数及按压镇痛泵次数。结果 三组患者术后2、12、24、48 h的静息VAS评分和运动VAS评分呈升高后下降趋势,对照组、腰方肌组和普瑞巴林组各时间点的静息和运动VAS评分依次降低,各组间均有统计学差异(P＜0.05);对照组(40.1%)、腰方肌组(18.9%)、普瑞巴林组(9.1%)术后恶心呕吐发生率依次降低,普瑞巴林组与对照组比较有统计学差异(P＜0.05)。普瑞巴林组术中舒芬太尼及瑞芬太尼的使用量明显少于腰方肌组,后者又少于对照组,差异均有统计学意义(P＜0.05);普瑞巴林组、腰方肌组、对照组术后首次下地时间、排气时间、饮水时间、按压镇痛泵次数依次缩短或减少(P＜0.05)。结论 术前口服普瑞巴林联合超声下双侧腰方肌阻滞用于腹腔镜结直肠癌根治术后患者,可以获得良好的镇痛效果,并减少阿片类药物使用量,降低术后恶心呕吐的发生率,有利于患者术后康复。
Abstract
Objective To explore the effect of pregabalin combined with in quadratus lumborum block anesthesia patients undergoing radical surgery of colorectal cancer.Methods Sixty-six patients who met the requirements after radical surgery of colorectal cancer from January to October 2022 were selected and randomly divided into a control group (n=22), a quadratus lumborum block anesthesia group (n=22) and a pregabaline group (n=22). Patients in the three groups were treated with postoperative controlled intravenous analgesia (PCIA). Patients in the pregabalin group, the quadratus lumborum block anesthesia group and the quadratus lumborum block after anesthesia induction. Patients in the pregabalin group received 150 mg pregabalin capsules before surgery, and 75 mg each at 8:00 p.m. on the first day and 30 minutes before surgery. Patients in quadiatus lumborum group and control group were given placebo at the same time. VAS score, intraoperative dosage of sufentanil and remifentanil, serum CRP and cortisol concentrations 1 day before surgery and 15 min after skin resection, 24 h and 48 h after surgery, vital signs before surgery and 15 min after skin resection, and adverse reactions 2 days after surgery, as well as the time of landing,exhausting,drinking and hospitalization after operation and the number of times to press the analgesic pump, were all compared among the three groups.Results At 2, 12, 24 and 48 h after surgery, the resting VAS score and exercise VAS score of the three groups increased and then decreased, while the resting VAS score and exercise VAS score of the control group, quadratus lumborum group and pregabalin group decreased successively at each time point, with statistical differences among the groups (P<0.05). The incidence of postoperative nausea and vomiting in the control group (40.1%), quadratus lumborum group (18.9%) and pregabalin group (9.1%) decreased successively, and there was a statistical difference between pregabalin group and control group (P<0.05). The intraoperative usage of sufentanil and remifentanil in pregabalin group was significantly lower than that in quadratus lumborum group, and the latter was lower than that in control group, with statistical significance (P<0.05). In pregabalin group, quadratus lumborum block anesthesia group; and control group, the time of first postoperative landing, exhausting, drinking and the number of pressing the analgesic pump were successively shortened or decreased (P<0.05).Conclusions Preoperative oral pregabalin combined with ultrasound in bilateral quadratus lumborum block anesthesia; for patients after laparoscopic radical surgery of colorectal cancer can achieve good analgesic effect, reduce the use of opioid drugs, reduce the incidence of postoperative nausea and vomiting, and facilitate postoperative rehabilitation of patients.
关键词
普瑞巴林 /
腰方肌阻滞 /
结直肠癌根治术 /
术后康复 /
术后疼痛
Key words
pregabalin /
quadratus lumborum block anesthesia /
radical surgery of colorectal cancer /
postoperative rehabilitation /
postoperative pain
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基金
北京科委培育项目(Z 161100000 116074)
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