地塞米松联合肋间神经阻滞对腹腔镜胆囊切除术患者术后疼痛及恢复的影响

中国临床药理学与治疗学 ›› 2009, Vol. 14 ›› Issue (12): 1406-1409.

地塞米松联合肋间神经阻滞对腹腔镜胆囊切除术患者术后疼痛及恢复的影响

陈玲阳, 彭从斌, 王惠琴

浙江省台州医院麻醉科, 台州 317000, 浙江

收稿日期:2009-11-03 修回日期:2009-11-16 发布日期:2020-10-20
通讯作者: 彭从斌, 男, 主任医师, 主要研究方向:临床麻醉。Tel:0576-853120120-6452 E-mail:pengcb@tzhospital.com
作者简介:陈玲阳, 女, 硕士, 住院医师, 主要研究方向:麻醉与器官保护。Tel:13757600208 E-mail:chenly1306@yahoo.com.cn

Effects of intercostals neural blockade combining with intravenous dexamethasone on postoperative pain, nausea and vomiting and rehabilitation after laparoscopic cholecystectomy

CHEN Ling-yang, PENG Cong-bing, WANG Hui-qin

Department of Anesthesiology, Taizhou Hospital of Zhejiang Province, Taizhou 317000, Zhejiang, China

Received:2009-11-03 Revised:2009-11-16 Published:2020-10-20

摘要/Abstract

摘要： 目的：观察静脉注射地塞米松复合肋间神经阻滞对腹腔镜胆囊切除术患者术后疼痛、恶心呕吐及预后的影响。方法：择期行腹腔镜胆囊切除术患者72 例, 随机分为3 组:地塞米松+肋间神经阻滞组, 肋间神经阻滞组和对照组, 每组24例。记录术中丙泊酚和瑞芬太尼的使用量;采用VAS 量表对术后患者1 、4 、12 、24 h 进行疲乏、静息和咳嗽时疼痛评分;记录发生恶心呕吐例数, 首次肠蠕动、肠排气和出院时间。结果：地塞米松+肋间神经阻滞组和肋间神经阻滞组丙泊酚和瑞芬太尼用量、术后疼痛和术后4 、12 、24 h 疲乏评分、恶心呕吐发生率、首次肠蠕动、肠排气时间和住院时间明显少于对照组(P <0.01, P <0.05);与地塞米松+肋间神经阻滞组比较, 肋间神经阻滞组瑞芬太尼用量、术后1 、4 、12 h 咳嗽时疼痛评分、首次肠蠕动、肠排气时间明显多于地塞米松+肋间神经阻滞组(P <0.05, P <0.01)。结论：肋间神经阻滞能有效地减轻腹腔镜胆囊切除术患者术后疼痛, 地塞米松能有效地减少恶心呕吐发生;地塞米松联合应用肋间神经阻滞镇痛效果更确切,有助于患者术后早期恢复。

关键词: 肋间神经阻滞, 地塞米松, 术后疼痛, 恶心呕吐, 腹腔镜胆囊切除术

Abstract: AIM: To investigate the effect of intercostals neural blockade(INB)combining with intravenous dexamethasone on postoperative pain, nausea and vomiting and rehabilitation after laparoscopic cholecystectomy( LC).METHODS: Seventy-two patients with ASA I-Ⅱ undergoing LC were randomly divided into three groups with twenty-four patients in each group. Group DI received intravenous dexamethasone infusion before induction combining with INB.Group I only received INB.Group C was control group.Propofol and remifentanil consumption were recorded, postoperative pain and fatigue were assessed according to a pain and fatigue severity score using a subjective analog visual scale (VAS)1, 4, 12, and 24 h after the surgery.The incidence of postoperative nausea and vomiting, times to first enterocinesia, flatus and hospital discharge were recorded.RESULTS: Propofol and remifentanil consumption, postoperative pain and fatigue scores 4, 12, 24 h after surgery, the postoperative nausea and vomiting incidences, times to first enterocinesia and flatus, times to hospital discharge were significantly lower in Group DI and I than those in Group C(P <0.05, P < 0.01).Remifentanil consumption, and the pain score when coughing at 1, 4, 12 h after surgery, times to first enterocinesia and flatus were significantly higher in Group I as compared with Group DI(P <0.05, P < 0.01).CONCLUSION: INB is used safely to reduce the postoperative pain and dexamethasone is effective to reduce postoperative nausea and vomiting.Furthermore, INB combining with intravenous dexamethasone reduce postoperative painmore effectively.Meanwhile, it accelerates the postoperative acute rehabilitation.

Key words: intercostals neural blockade, dexamethasone, postoperative pain, nausea and vomiting, laparoscopic cholecystectomy

中图分类号:

R614

陈玲阳, 彭从斌, 王惠琴. 地塞米松联合肋间神经阻滞对腹腔镜胆囊切除术患者术后疼痛及恢复的影响[J]. 中国临床药理学与治疗学, 2009, 14(12): 1406-1409.

CHEN Ling-yang, PENG Cong-bing, WANG Hui-qin. Effects of intercostals neural blockade combining with intravenous dexamethasone on postoperative pain, nausea and vomiting and rehabilitation after laparoscopic cholecystectomy[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2009, 14(12): 1406-1409.

参考文献

[1] Chung F, Tong D, Miceli PC, et al.Controlled-release codeine is equivalent to acetaminophen plus codeine for post-cholecystectomy analgesia[J].Can J Anesth, 2004, 51(3):216-221.
[2] Vieira MV, Schnaider TB, Brando A, et al.Comparative study of intercostal and interpleural blockade for postcholecytectomy analgesia[J].Rev Bras Anestesiol, 2003, 53(3):346-350.
[3] Fujii Y, Itakura M.Reduction of postoperative nausea, vomiting, and analgesic requirement with dexamethasone for patients undergoing laparoscopic cholecystectomy[J]. Surg Endosc, 2009 Aug 19.[Epub ahead of print] [4] Takamori S, Yoshida S, Hayashi A, et al.Intraoperative intercostals nerve blockade for postthoracotomy pain[J]. Ann Thorac Surg, 2002, 74(2):338-341.
[5] Pourseidi A, Manesh K.Effect of intercostals neural blockade with Marcaine (bupivacaine) on postoperative pain after laparoscopic cholecystectomy[J].Surg Endosc, 2007, 21(9):1557-1559.
[6] 孙正怡, 冷金花, 郎景和.腹腔镜手术后疼痛[J].中国现代手术学杂志, 2000, 4(4):309-311.
[7] Detterbeck FC.Efficacy of methods of intercostals nerve blockade for pain relief after thoracotomy[J].Ann Thorac Surg, 2005, 80(4):1550-1559.
[8] Jokela RM, Ahonen J, Tallgren M, et al.The effective analgesic dose of dexamethasone after laparoscopic hysterectomy[J].Anesth-Analg, 2009, 109(2):607-615.
[9] 郭伟, 金孝山巨, 郭建荣, 等.氯诺昔康联合地塞米松超前镇痛用于下肢手术的临床观察[J].中国临床药理学与治疗学, 2009, 14(3):337-341.
[10] Sapolsky RM, Romero LM, Munck AU, et al.How do glucocorticoids influence stress responses? Integrating permissive, suppressive, stimulatory, and preparative actions[J].Endocr Rev, 2000, 21(1):55-89.
[11] FredriksonM, Hursti T, Furst CJ, et al.Nausea in cancer chemotherapy isinversely related to urinary cortisol excretion[J].Br J Cancer, 1992, 65(5):779-780.

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