多模式镇痛在混合痔外剥内扎术后的应用效果
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摘要
目的探讨多模式镇痛对混合痔外剥内扎术术后恢复的影响。方法选取2017年3月～2018年6月在我院住院治疗的60例混合痔患者作为研究对象,随机分为治疗组和对照组,每组各30例。两组均采用罗哌卡因100 mg、利多卡因200 mg混合液局部麻醉行混合痔外剥内扎术,治疗组术后采用多模式镇痛方案,对照组术后按需镇痛。治疗后于术后24 h、术后第3、7天、出院当日、出院后第一次复诊、最后一次复诊比较两组患者的疼痛视觉模拟评分(VAS)、术后并发症发生情况、术后住院时间、达到伤口完全愈合的复诊次数和治疗总满意度。结果治疗组患者各时间节点的VAS评分、术后并发症发生率低于对照组,差异均有统计学意义(P<0.05);治疗组患者术后住院时间短于对照组,复诊次数少于对照组,差异均有统计学意义(P<0.05);治疗组患者的治疗总满意度高于对照组,差异有统计学意义(P<0.05)。结论混合痔外剥内扎术术后采用多模式镇痛效果显著,可促进患者术后恢复,减少术后并发症的发生,提高患者的治疗满意度,值得临床推广应用。
Objective To explore the effect of multimodal analgesia after milligan-morgan hemorrhoidectomy. Methods Sixty patients with mixed hemorrhoids who were hospitalized in our hospital from March 2017 to June 2018 were selected as the research objects, they were randomly divided into treatment group and control group, with 30 cases in each group. Both groups were treated with topical anesthesia with Ropivacaine 100 mg and Lidocaine 200 mg mixture for exfoliation and internal ligation of mixed hemorrhoids, the treatment group received multimodal analgesia after operation, while the control group received on-demand analgesia after operation. The pain visual analogue score(VAS),complications, hospitalization time, number of visits to complete wound healing and total satisfaction with treatment were compared between the two groups at 24 hours, 3 rd, 7 thday, discharge day, first and last visits. Results The VAS score and the incidence of postoperative complications in the treatment group were lower than those in the control group, the differences were statistically significant(P<0.05). The hospitalization time of patients in the treatment group was shorter than that in the control group, and the visits times in the treatment group were fewer than those in the control group, the differences were statistically significant(P<0.05). The total satisfaction of patients in the treatment group was higher than that in the control group, the difference was significant(P<0.05). Conclusion Multimodal analgesia after combined hemorrhoids stripping and internal ligation is effective, it can promote the recovery of patients after operation, reduce the occurrence of postoperative complications, and improve patients′ satisfaction with treatment. It is worthy of clinical application.
Objective To explore the effect of multimodal analgesia after milligan-morgan hemorrhoidectomy. Methods Sixty patients with mixed hemorrhoids who were hospitalized in our hospital from March 2017 to June 2018 were selected as the research objects, they were randomly divided into treatment group and control group, with 30 cases in each group. Both groups were treated with topical anesthesia with Ropivacaine 100 mg and Lidocaine 200 mg mixture for exfoliation and internal ligation of mixed hemorrhoids, the treatment group received multimodal analgesia after operation, while the control group received on-demand analgesia after operation. The pain visual analogue score(VAS),complications, hospitalization time, number of visits to complete wound healing and total satisfaction with treatment were compared between the two groups at 24 hours, 3 rd, 7 thday, discharge day, first and last visits. Results The VAS score and the incidence of postoperative complications in the treatment group were lower than those in the control group, the differences were statistically significant(P<0.05). The hospitalization time of patients in the treatment group was shorter than that in the control group, and the visits times in the treatment group were fewer than those in the control group, the differences were statistically significant(P<0.05). The total satisfaction of patients in the treatment group was higher than that in the control group, the difference was significant(P<0.05). Conclusion Multimodal analgesia after combined hemorrhoids stripping and internal ligation is effective, it can promote the recovery of patients after operation, reduce the occurrence of postoperative complications, and improve patients′ satisfaction with treatment. It is worthy of clinical application.
引文
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[13]陆双伟,樊志敏,朱勇,等.多模式镇痛应用于混合痔术后镇痛的临床观察[J].中国医药导报,2015,12(34):94-97.
[14]孙静怡,陈长香.耳穴贴压对混合痔术后疼痛及排尿功能的影响[J].贵阳中医学院学报,2016,38(2):49-52.
[15]陈瑞海,周勤,孙余挺,等.环状混合痔患者围手术期多模式镇痛的研究[J].中华胃肠外科杂志,2011,14(3):214-215.
[16]何媛明,曾兰丹,梁家芝,等.预防混合痔术后尿潴留的中西医研究进展[J].内蒙古中医药,2017,36(18):121-122.
[17]张威,王荣.不同种类止痛药对肛肠病术后镇痛的疗效观察[J].中国疼痛医学杂志,2016,22(5):398-400.
[2]黄河,池伟,蔡丽群.多模式镇痛疗法在重度混合痔术后的应用[J].浙江临床医学,2016,18(11):2077-2078.
[3]李贵信,王默非.痔病患者术后疼痛流行病学调查及相关因素分析[J].中国肛肠病杂志,2006,26(4):24-26.
[4]中华医学会外科学分会结直肠肛门外科学组,中华中医药学会肛肠病专业委员会,中国中西医结合学会结直肠肛门病专业委员会.痔临床诊治指南(2006版)[J].中华胃肠外科杂志,2006,9(5):461-463.
[5]王波,旷昕,田绍文.帕瑞昔布钠的作用机制及最新进展[J].海南医学,2014,25(23):3496-3499.
[6]中华医学会麻醉学分会.成人术后疼痛处理专家共识[J].临床麻醉学杂志,2010,26(3):190-196.
[7]周军,史仁杰.肛肠病术后疼痛研究进展[J].中国中医急症,2011,20(5):775-776.
[8]Kehlet H.Multimodal approach to control postoperative pathophysiology and rehabilitation[J].Br J Anaesth,1997,78(5):606-617.
[9]江志伟,李宁,黎介寿.快速康复外科的概念及临床意义[J].中国实用外科杂志,2007,2(27):131-133.
[10]王雅琴,宁宁,何凌霄,等.快速康复外科理念在胃肠外科中的应用进展[J].华西医学,2012,27(1):155-157.
[11]张会东.多模式镇痛的临床研究现状[J].医学综述,2011,17(7):1072-1075.
[12]路强,丁路,郭玲玲,等.混合痔术后多模式镇痛的效果分析[J].安徽医学,2018,39(5):556-559.
[13]陆双伟,樊志敏,朱勇,等.多模式镇痛应用于混合痔术后镇痛的临床观察[J].中国医药导报,2015,12(34):94-97.
[14]孙静怡,陈长香.耳穴贴压对混合痔术后疼痛及排尿功能的影响[J].贵阳中医学院学报,2016,38(2):49-52.
[15]陈瑞海,周勤,孙余挺,等.环状混合痔患者围手术期多模式镇痛的研究[J].中华胃肠外科杂志,2011,14(3):214-215.
[16]何媛明,曾兰丹,梁家芝,等.预防混合痔术后尿潴留的中西医研究进展[J].内蒙古中医药,2017,36(18):121-122.
[17]张威,王荣.不同种类止痛药对肛肠病术后镇痛的疗效观察[J].中国疼痛医学杂志,2016,22(5):398-400.