腰俞穴麻醉配合静脉麻醉运用于痔术中的临床研究
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摘要
目的：通过对比观察腰俞穴麻醉配合静脉麻醉和腰俞穴麻醉在肛肠科痔术中的应用,指出两种麻醉方式各自的优势和不足,进一步完善肛肠科手术的麻醉方式,以更加安全有效舒适的手段保证手术的顺利进行。
方法：将236例来自成都肛肠专科医院的病人随机分入腰俞穴麻醉配合静脉麻醉组(以下称试验组)和腰俞穴麻醉组(以下称对照组),其中试验组118例,对照组118例。进行前瞻性的临床观察,并记录两组病例术中及术后一日相关的评价指标(肛门松弛、牵拉反射、麻醉药物不良反应、紧张度、术后情绪状况、术中疼痛、紧张感、舒适度、总体满意度),应用医学统计学软件SPSS对结果进行对比分析,当P>0.05时表示差异无统计学意义,P<0.05时表示差异有显著性意义。
结果：试验组病例术中VAS平均分值为(2.06±0.11)与对照组VAS平均分值(3.77±6.45)之间有显著性差异(P<0.05),且在牵拉反射、紧张度、舒适度、满意度及术后情绪状况等方面也有显著性差异(P<0.05),而两组在肛门松弛、麻醉药物不良反应方面差异无统计学意义(P>0.05)。
结论：腰俞穴麻醉配合静脉麻醉在肛肠科术中的应用,相较于单纯的腰俞穴麻醉具有起效苏醒快、麻醉完全、术中舒适无不良记忆、术后无明显并发症等优势,在有效缓解病人术中紧张感并提高手术舒适度的同时,也保证了临床医生手术操作的顺利进行,患者在睡眠状态下完成手术,全程处于安静、舒适、无痛状态,满意度高,是能令病人和手术医生均满意的一种麻醉方式,也是肛肠手术操作中一种安全有效的麻醉方式,具有较好的临床使用价值及较高的推广价值。
Objective: Find out the respective advantages and disadvantages of waist shu points anesthesia with intravenous anesthesia and waist shu points anesthesia by paired ovserving the usage of them in hemorrhoid surgery, making further efforts to perfect the anesthesia of the hemorrhoid surgery and ensuring the surgery safer and more effective.
Methods:236 cases of patients from Chengdu special Anorectal hospital were randomly divided into the waist shu points anesthesia with intravenous anesthesia group (hereinafter referred to the test group) and waist shu points anesthesia group (hereinafter referred to the control group),118 cases in trial group and 118 cases in control group. Prospectively clinical observing and recording the relative evaluating indicator(including pain in the surgery, stretch reflex, adverse reactions to the anesthesia drug, anal laxation, tensity, degree of comfort, emotional stats during up period and so on) in and one day after the surgery of the two cases, then the application medical statistics software SPSS is used to analyze the results. When P>0.05 it denotes that the different has little statistic significance. When P<0.05 denotes that the different has great significance.
Outcome:VAS average score in surgery of the test group is 2.06±0.11 and the control group is 3.77±6.45, it has significant difference (P<0.05). There is also significant difference in pain in the surgery, stretch reflex, tensity, degree of comfort, emotional stats during up period. But the two groups have little statistic significance in anal laxation,untoward effect of the anesthesia drug(P>0.05).
Conclusion:Waist shu points anesthesia with intravenous anesthesia in anorectal surgery has the advantage of rapid taking effect and coming round, absolute anesthesia, comfort and no adverse reactions in surgery, no patent complications after the surgery comparing with the simplex waist shu points anesthesia. It can effetely relieve tension of the patients in the surgeries and improve the comfort level of the surgery, also ensure the going well of the clinical surgery. The patients complete the surgeries in sleep, being silent and painless in the whole process and having high satisfaction. The waist shu points anesthesia with intravenous is a safe and effective anesthesia manner and may satisfy both the patients and doctors, having better clinical usage and popularization values.
方法：将236例来自成都肛肠专科医院的病人随机分入腰俞穴麻醉配合静脉麻醉组(以下称试验组)和腰俞穴麻醉组(以下称对照组),其中试验组118例,对照组118例。进行前瞻性的临床观察,并记录两组病例术中及术后一日相关的评价指标(肛门松弛、牵拉反射、麻醉药物不良反应、紧张度、术后情绪状况、术中疼痛、紧张感、舒适度、总体满意度),应用医学统计学软件SPSS对结果进行对比分析,当P>0.05时表示差异无统计学意义,P<0.05时表示差异有显著性意义。
结果：试验组病例术中VAS平均分值为(2.06±0.11)与对照组VAS平均分值(3.77±6.45)之间有显著性差异(P<0.05),且在牵拉反射、紧张度、舒适度、满意度及术后情绪状况等方面也有显著性差异(P<0.05),而两组在肛门松弛、麻醉药物不良反应方面差异无统计学意义(P>0.05)。
结论：腰俞穴麻醉配合静脉麻醉在肛肠科术中的应用,相较于单纯的腰俞穴麻醉具有起效苏醒快、麻醉完全、术中舒适无不良记忆、术后无明显并发症等优势,在有效缓解病人术中紧张感并提高手术舒适度的同时,也保证了临床医生手术操作的顺利进行,患者在睡眠状态下完成手术,全程处于安静、舒适、无痛状态,满意度高,是能令病人和手术医生均满意的一种麻醉方式,也是肛肠手术操作中一种安全有效的麻醉方式,具有较好的临床使用价值及较高的推广价值。
Objective: Find out the respective advantages and disadvantages of waist shu points anesthesia with intravenous anesthesia and waist shu points anesthesia by paired ovserving the usage of them in hemorrhoid surgery, making further efforts to perfect the anesthesia of the hemorrhoid surgery and ensuring the surgery safer and more effective.
Methods:236 cases of patients from Chengdu special Anorectal hospital were randomly divided into the waist shu points anesthesia with intravenous anesthesia group (hereinafter referred to the test group) and waist shu points anesthesia group (hereinafter referred to the control group),118 cases in trial group and 118 cases in control group. Prospectively clinical observing and recording the relative evaluating indicator(including pain in the surgery, stretch reflex, adverse reactions to the anesthesia drug, anal laxation, tensity, degree of comfort, emotional stats during up period and so on) in and one day after the surgery of the two cases, then the application medical statistics software SPSS is used to analyze the results. When P>0.05 it denotes that the different has little statistic significance. When P<0.05 denotes that the different has great significance.
Outcome:VAS average score in surgery of the test group is 2.06±0.11 and the control group is 3.77±6.45, it has significant difference (P<0.05). There is also significant difference in pain in the surgery, stretch reflex, tensity, degree of comfort, emotional stats during up period. But the two groups have little statistic significance in anal laxation,untoward effect of the anesthesia drug(P>0.05).
Conclusion:Waist shu points anesthesia with intravenous anesthesia in anorectal surgery has the advantage of rapid taking effect and coming round, absolute anesthesia, comfort and no adverse reactions in surgery, no patent complications after the surgery comparing with the simplex waist shu points anesthesia. It can effetely relieve tension of the patients in the surgeries and improve the comfort level of the surgery, also ensure the going well of the clinical surgery. The patients complete the surgeries in sleep, being silent and painless in the whole process and having high satisfaction. The waist shu points anesthesia with intravenous is a safe and effective anesthesia manner and may satisfy both the patients and doctors, having better clinical usage and popularization values.
引文
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7吕晨等.视觉模拟量表和语言评价量表用于术后疼痛评估的比较.全科医学临床与教育,2004,2(4)：214-216.
8陈蓉等.影响我国术后急性疼痛治疗的伦理学问题及对策.中华医学丛刊,2003,3(6)：88-89.
9卢启华等.医学伦理学.第2版.武汉：华中科技大学出版社,1999
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21黄乃健.中国肛肠病学[M].第一版.山东：科学技术出版社,1996,391
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2于布为,赵欣.疼痛机制研究进展.现代临床医学外科进展麻醉分册.北京：科学技术文献出版社,2006：44-51
3张立生,刘小立.现代疼痛学.石家庄：河北科学技术出版社,1999：572
4谭冠华.疼痛诊疗学.北京：人民卫生出版社,2000：167
5倪家骧,樊碧发,薛富善.临床疼痛治疗技术.北京：科学技术文献出版社.2003
6张传汉,田玉科.临床疼痛治疗指南.北京：中国中医药科技出版社2007
7贝绍生,朱慧卿.肛肠科常用止痛方药的应用.山东中医杂志,2003,22(1)：60-61
8江苏新医学院.中药大辞典[S].上海：上海科学技术出版社,1993：677
9荣文舟.肛肠科常见疼痛的辩证治疗.中国临床医生,2001,29(6)：46
10王晓林,廖行忠,李东平等.现代肛肠科学[M].成都中医药大学自编教材
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12丁义江.丁氏肛肠病学[M].北京：人民卫生出版社,2006：176-200
13黄乃健.中国肛肠病学[M].第一版.山东：科学技术出版社,1996,391
14张东铭,王玉成.盆底与肛门病学[M].第一版.贵阳：贵州科技出版社.2000,664-674
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16马志华.骶麻324例临床分析[J].工企医刊,2002,15(1)：36-37
17刘俊杰,赵俊.现代麻醉学[M].第二版.北京：人民卫生出版社,1996,644-790
18邢喜平,廖行忠.腰俞穴麻醉在肛肠手术131例的临床观察[J].结直肠肛门外科,2008,14(2)：111-112
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2 Melazck R. Pain Measurement and Assessment[M]. New York:Press,1983
3 Melazck R. McGill pain questionnaire:major properitids and scoring mathods[J].Pain,1:277
4张传汉,田玉科.临床疼痛治疗指南.北京：中国中医药科技出版社,2007
5赵俊,李树人,宋文阁.疼痛诊断治疗学.郑州：河南医科大学出版社,1999
6 Patrick D. Wall, Ronald Melzack. Text book of pain. New York:Harcourt Publishers,1999
7吕晨等.视觉模拟量表和语言评价量表用于术后疼痛评估的比较.全科医学临床与教育,2004,2(4)：214-216.
8陈蓉等.影响我国术后急性疼痛治疗的伦理学问题及对策.中华医学丛刊,2003,3(6)：88-89.
9卢启华等.医学伦理学.第2版.武汉：华中科技大学出版社,1999
10章军建,项红兵.临床疼痛诊断治疗新进展.太原：山西高校联合出版社,1994
11王启才.针灸治疗学[M].北京：中国中医药出版社,2003,48
12石学敏.针灸学[M].北京：中国中医药出版社,2002,105
13薛富善.临床局部麻醉技术[M],2005,第一版,326-329
14刘俊杰,赵俊.现代麻醉学[M].第二版.北京：人民卫生出版社,1996,644
15徐启明.临床麻醉学.北京：人民卫生出版社,2005
16周仁郁.SPSS13.0软件设计.成都：西南交通大学出版社
17王晓林,廖行忠等.现代肛肠科学[M].成都中医药大学自编教材
18陆德铭主编.普通高等教育中医药类规划教材·中医外科学.上海：上海科学技术出版社,1997.
19张东铭,王玉成.盆底与肛门病学[M].第一版.贵阳：贵州科技出版社.2000：664-674
20李仲廉等主编.临床疼痛治疗学.天津：天津科学技术出版社,2003.601
21黄乃健.中国肛肠病学[M].第一版.山东：科学技术出版社,1996,391
1[美]Wall,P.D. Textbook of Pain.Fourth Edition北京：科学出版社,2001
2于布为,赵欣.疼痛机制研究进展.现代临床医学外科进展麻醉分册.北京：科学技术文献出版社,2006：44-51
3张立生,刘小立.现代疼痛学.石家庄：河北科学技术出版社,1999：572
4谭冠华.疼痛诊疗学.北京：人民卫生出版社,2000：167
5倪家骧,樊碧发,薛富善.临床疼痛治疗技术.北京：科学技术文献出版社.2003
6张传汉,田玉科.临床疼痛治疗指南.北京：中国中医药科技出版社2007
7贝绍生,朱慧卿.肛肠科常用止痛方药的应用.山东中医杂志,2003,22(1)：60-61
8江苏新医学院.中药大辞典[S].上海：上海科学技术出版社,1993：677
9荣文舟.肛肠科常见疼痛的辩证治疗.中国临床医生,2001,29(6)：46
10王晓林,廖行忠,李东平等.现代肛肠科学[M].成都中医药大学自编教材
11徐启明.临床麻醉学.北京：人民卫生出版社,2005
12丁义江.丁氏肛肠病学[M].北京：人民卫生出版社,2006：176-200
13黄乃健.中国肛肠病学[M].第一版.山东：科学技术出版社,1996,391
14张东铭,王玉成.盆底与肛门病学[M].第一版.贵阳：贵州科技出版社.2000,664-674
15黄明,张卫萍,陈斌武.腰俞穴麻醉在肛肠手术中的应用[J].新疆中医药,2003,21(5)：37-38
16马志华.骶麻324例临床分析[J].工企医刊,2002,15(1)：36-37
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