丁丙诺啡透皮贴联合复方亚甲蓝注射液用于肛肠手术术后镇痛的效果
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摘要
目的研究丁丙诺啡透皮贴联合复方亚甲蓝注射液用于肛肠手术术后镇痛的效果。方法选取2017年1月‐2018年8月于该院择期行肛肠手术的患者160例,随机将其分为研究组(80例)及对照组(80例)。对照组术后肛周注射1%复方亚甲蓝2 ml+罗哌卡因10 ml+注射用水5 ml混合液,在此基础上,研究组加用丁丙诺啡透皮贴剂。观察两组不同时间点疼痛评分、镇静评分,同时比较两组应激激素水平及不良反应发生情况。结果研究组术后6、12及24 h的视觉模拟法(VAS)评分均低于对照组,差异有统计学意义(P<0.05),而两组Ramsay镇静评分差异无统计学意义(P>0.05);研究组术后24 h的超敏C反应蛋白(hs-CRP)、血浆皮质醇(COR)、肿瘤坏死因子-α(TNF-α)水平均明显低于对照组(P<0.05);此外,两组不良反应发生情况相仿,组间差异无统计学意义(P>0.05)。结论丁丙诺啡透皮贴联合复方亚甲蓝注射液对肛肠手术患者术后镇痛有良好效果,可明显改善患者术后应激反应,且安全性较佳,值得临床推荐。
【Objective】To study the effect of buprenorphine transdermal patch combined with methylene blue injection on analgesia after anorectal surgery.【Methods】A total of 160 patients who underwent elective anorectal surgery in our hospital from January 2017 to August 2018 were randomly divided into study group(80 cases) and control group(80 cases). In the control group, 2 ml 1% methylene blue + 10 ml ropivacaine + 5 ml water for injection was injected into the perianal area. On the basis of this, the study group was given a transdermal patch of buprenorphine. Pain scores and sedation scores were observed at different time points in the two groups. The levels of stress hormones and adverse reactions were compared between the two groups.【Results】The VAS scores of the observation group at 6 h, 12 h, and 24 h after operation were lower than those of the control group(P <0.05), but the Ramsay sedation scores of the two groups were not significantly different(P >0.05). The levels of hs-CRP, COR and TNF-α 24 hours after surgery of the observation group were significantly lower than those of the control group(P <0.05). In addition, the incidence of adverse reactions was similar in the two groups, and there was no significant difference between the two groups(P >0.05).【Conclusion】The combination of buprenorphine transdermal patch with methylene blue injection has a good effect on postoperative analgesia in patients with anorectal surgery, it can significantly improve the postoperative stress response, and is worthy of clinical recommendation with good safety.
【Objective】To study the effect of buprenorphine transdermal patch combined with methylene blue injection on analgesia after anorectal surgery.【Methods】A total of 160 patients who underwent elective anorectal surgery in our hospital from January 2017 to August 2018 were randomly divided into study group(80 cases) and control group(80 cases). In the control group, 2 ml 1% methylene blue + 10 ml ropivacaine + 5 ml water for injection was injected into the perianal area. On the basis of this, the study group was given a transdermal patch of buprenorphine. Pain scores and sedation scores were observed at different time points in the two groups. The levels of stress hormones and adverse reactions were compared between the two groups.【Results】The VAS scores of the observation group at 6 h, 12 h, and 24 h after operation were lower than those of the control group(P <0.05), but the Ramsay sedation scores of the two groups were not significantly different(P >0.05). The levels of hs-CRP, COR and TNF-α 24 hours after surgery of the observation group were significantly lower than those of the control group(P <0.05). In addition, the incidence of adverse reactions was similar in the two groups, and there was no significant difference between the two groups(P >0.05).【Conclusion】The combination of buprenorphine transdermal patch with methylene blue injection has a good effect on postoperative analgesia in patients with anorectal surgery, it can significantly improve the postoperative stress response, and is worthy of clinical recommendation with good safety.
引文
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[3]李祖希,裴杰,邵志强,等.关节腔持续输注镇痛合剂联用丁丙诺啡透皮贴在肩关节镜手术患者术后镇痛的效果[J].江苏医药, 2017, 43(6):422-424.
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[9]江先胜,安明伟,王娜,等.亚甲蓝注射液联合肛门洗剂治疗混合痔术后疼痛的临床观察[J].中西医结合研究, 2018(4):191-193.
[10]付松林,刘全印,贾旭,等.复方亚甲蓝联合布比卡因用于混合痔术后镇痛效果观察[J].人民军医, 2015, 12(10):1179-1180.
[11]张红波,彭乐锋,肖国明,等.丁丙诺啡透皮贴剂用于肛肠病术后镇痛的临床研究[J].齐齐哈尔医学院学报, 2016, 37(10):1293-1295.
[2]黄明标,邓志辉,邓兴华.复方亚甲蓝长效止痛剂用于肛肠科手术后止痛的效果及时机[J].实用中西医结合临床, 2018,18(14):28-30.
[3]李祖希,裴杰,邵志强,等.关节腔持续输注镇痛合剂联用丁丙诺啡透皮贴在肩关节镜手术患者术后镇痛的效果[J].江苏医药, 2017, 43(6):422-424.
[4]Fransiska D, Jeo WS, Moenadjat Y, et al. Methylene blue effectiveness as local analgesic after anorectal surgery:a literature review[J]. Adv Med, 2017, 2017:3968278.
[5]胡宝良,宋长鹏.罗哌卡因复合舒芬太尼骶管阻滞用于肛肠手术后镇痛的效果观察[J].临床医药文献电子杂志, 2017, 4(2):210-211.
[6]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.
[7]李大淦.肛肠病患者术后疼痛的机理及对其进行治疗的方法探讨[J].当代医药论丛, 2015, 13(9):285-286.
[8]王森,马敏,李建国.罗哌卡因复合舒芬太尼骶管阻滞用于肛肠手术后镇痛的效果观察[J].结直肠肛门外科, 2017, 5(s1):89-91.
[9]江先胜,安明伟,王娜,等.亚甲蓝注射液联合肛门洗剂治疗混合痔术后疼痛的临床观察[J].中西医结合研究, 2018(4):191-193.
[10]付松林,刘全印,贾旭,等.复方亚甲蓝联合布比卡因用于混合痔术后镇痛效果观察[J].人民军医, 2015, 12(10):1179-1180.
[11]张红波,彭乐锋,肖国明,等.丁丙诺啡透皮贴剂用于肛肠病术后镇痛的临床研究[J].齐齐哈尔医学院学报, 2016, 37(10):1293-1295.