局部麻醉和持续硬膜外麻醉在腹股沟疝无张力修补术中的应用效果比较
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摘要
目的比较局部麻醉和持续硬膜外麻醉在腹股沟疝无张力修补术中的效果。方法选择2017年2月至2018年10月在该院普外科进行腹股沟疝无张力修补术的患者80例,按照随机数字表法分为对照组和观察组,每组40例。观察组施行局部麻醉,对照组实施持续硬膜外麻醉。比较两组麻醉起效时间、手术时间、术后进食时间、术后下地活动时间、术后排气时间、恢复正常生活时间和住院费用;比较两组患者在术后4h卧床状态下的疼痛程度;比较两组患者并发症的发生情况;比较两组患者的满意度。结果两组患者在麻醉起效时间、手术时间和恢复正常生活时间上比较,差异均无统计学意义(P>0.05);与对照组比较,观察组术后进食时间、术后排气时间、术后下地活动时间、住院时间及住院费用减少(P<0.01);术后4h的卧床状态下观察组疼痛程度小于对照组(P<0.05);两组患者术后血压升高、恶心呕吐、眩晕、阴囊水肿、尿潴留及视觉模拟评分>5分等不良反应的发生率比较,差异均无统计学意义(P>0.05);观察组总满意度高于对照组(P<0.05)。结论采用局部麻醉进行腹股沟疝无张力修补术可以在手术后获得更好的镇痛效果,缩短患者住院时间,降低患者医疗费用,提高患者满意度,适宜在临床推广。
Objective To compare the effects between local anesthesia versus continuous epidural anesthesia in tension-free inguinal hernia repair.Methods Eighty patients undergoing tension-free inguinal hernia repair in the general surgery department of the hospital from February 2017 to October 2018 were selected and divided into the control group and observation group according to the random number table method,40 cases in each group.The observation group was given local anesthesia and the control group was given continuous epidural anesthesia.The onset time of anesthesia,operation time,postoperative eating time,postoperative movement time,postoperative exhaust time,hospitalization expenses and time to return to normal life were compared between the two groups.The pain degree in bed state at postoperative 4 hwas compared between the two groups.The complication occurrence situation was compared between the two groups.The satisfactions were compared between the two groups.Results There was no statistically significant difference in the onset time of anesthesia,operation time and time for returning to normal life between the two groups(P>0.05).Compared with the control group,the postoperative eating time,postoperative exhausting time,going to the ground after operation,hospitalization time and hospitalization cost in the observation group were reduced(P<0.01).The pain degree in bed state at postoperative 4 hin the observation group was less than that in the control group.There were no statistically significant differences in the incidence of adverse reactions such as elevated blood pressure,nausea and vomiting,vertigo,VAS score>5,scrotal edema and urinary retention between the two groups(P>0.05).The satisfaction of the observation group was higher than that of the control group(P<0.05).Conclusion Local anesthesia for tension-free repair of inguinal hernia can obtain better analgesic effect after operation,shorten the hospitalization time,reduce the medical expenses and improve the patient satisfaction,which is worthy of promotion in clinic.
Objective To compare the effects between local anesthesia versus continuous epidural anesthesia in tension-free inguinal hernia repair.Methods Eighty patients undergoing tension-free inguinal hernia repair in the general surgery department of the hospital from February 2017 to October 2018 were selected and divided into the control group and observation group according to the random number table method,40 cases in each group.The observation group was given local anesthesia and the control group was given continuous epidural anesthesia.The onset time of anesthesia,operation time,postoperative eating time,postoperative movement time,postoperative exhaust time,hospitalization expenses and time to return to normal life were compared between the two groups.The pain degree in bed state at postoperative 4 hwas compared between the two groups.The complication occurrence situation was compared between the two groups.The satisfactions were compared between the two groups.Results There was no statistically significant difference in the onset time of anesthesia,operation time and time for returning to normal life between the two groups(P>0.05).Compared with the control group,the postoperative eating time,postoperative exhausting time,going to the ground after operation,hospitalization time and hospitalization cost in the observation group were reduced(P<0.01).The pain degree in bed state at postoperative 4 hin the observation group was less than that in the control group.There were no statistically significant differences in the incidence of adverse reactions such as elevated blood pressure,nausea and vomiting,vertigo,VAS score>5,scrotal edema and urinary retention between the two groups(P>0.05).The satisfaction of the observation group was higher than that of the control group(P<0.05).Conclusion Local anesthesia for tension-free repair of inguinal hernia can obtain better analgesic effect after operation,shorten the hospitalization time,reduce the medical expenses and improve the patient satisfaction,which is worthy of promotion in clinic.
引文
[1]周国伟,边丹秀,徐萌艳.腰麻及硬膜外麻醉联合应用于产科分娩镇痛的临床探讨[J].中国性科学,2016,25(1):120-122.
[2]程静,李娜,乐呈进,等.剖宫产术后不同镇痛模式对新生儿神经和适应能力的影响[J].河北医药,2015,37(23):3535-3537.
[3]谭选军,申黎光,张川,等.腰硬联合麻醉与持续硬膜外麻醉用于剖宫产术的效果对比分析[J].陕西医学杂志,2015,44(2):180-182.
[4]王伟录,李巧星,王勇,等.硬膜外麻醉联合膀胱穿刺局部麻醉在膀胱侧壁肿瘤电切术中的应用[J].现代泌尿外科杂志,2017,22(2):116-118.
[5]邢国圣,张俊晶,任建军,等.局部麻醉腹股沟疝无张力修补术在老年患者治疗中的体会[J].中国普外基础与临床杂志,2016,23(7):858-860.
[6]丁世美,肖东霖,朱瑞凌,等.经腹腹膜前疝修补术45例临床观察[J/CD].中华疝和腹壁外科杂志(电子版),2015,9(2):151-152.
[7]吴聪.腹壁切口疝采用无张力修补术治疗的临床研究[J].中国医药指南,2016,14(36):157-158.
[8]GONULLU N N,CUBUKCU A,ALPONAT A.Comparison of local and general anesthesia in tension-free Lichtenstein hernioplasty:aprospective randomized trial[J].Hernia,2002,6(1):29-32.
[9]杨帅帅,李海玲,崔景利,等.3D腹腔镜联合杂交技术在腹壁巨大切口疝中的应用体会[J].腹腔镜外科杂志,2016,21(12):929-931.
[10]SANJAY P,WOODWARD A.Local versus general anaesthesia with prolene hernia system mesh for inguinal hernia repair:early and long-term outcomes[J].Dig Surg,2008,25(5):347-350.
[11]院存珍,樊晨.部分可吸收补片无张力修补术治疗腹壁切口疝30例临床观察[J/CD].中华疝和腹壁外科杂志(电子版),2015,9(2):15-16.
[12]GULTEKIN F A,KURUKAHVECIOGLU O,KURU-AHVECIOGLU O,et al.A prospective comparison of local and spinal anesthesia for inguinal hernia repair[J].Hernia,2007,11(2):153-156.
[13]吴华苗,张永年,徐小想.局部神经阻滞麻醉在老年腹股沟疝无张力疝修补术中的临床应用[J/CD].中华疝和腹壁外科杂志(电子版),2015,9(6):519-520.
[14]叶林,王健,周俊强.七氟烷复合舒芬太尼静脉麻醉在小儿腹腔镜疝气修复术中的应用[J].海南医学,2016,12(27):4097-4099.
[15]吴雪峰.腹股沟疝术后疼痛原因及其治疗方法探究[J].中国农村卫生,2016,10(20):8-9.
[16]KINGSNORTH A N,BOWLEY D M,PORTER C.Aprospective study of 1 000hernias:results of the plymouth hernia service[J].Ann R Coll Surg Engl,2003,85(1):18-22.
[2]程静,李娜,乐呈进,等.剖宫产术后不同镇痛模式对新生儿神经和适应能力的影响[J].河北医药,2015,37(23):3535-3537.
[3]谭选军,申黎光,张川,等.腰硬联合麻醉与持续硬膜外麻醉用于剖宫产术的效果对比分析[J].陕西医学杂志,2015,44(2):180-182.
[4]王伟录,李巧星,王勇,等.硬膜外麻醉联合膀胱穿刺局部麻醉在膀胱侧壁肿瘤电切术中的应用[J].现代泌尿外科杂志,2017,22(2):116-118.
[5]邢国圣,张俊晶,任建军,等.局部麻醉腹股沟疝无张力修补术在老年患者治疗中的体会[J].中国普外基础与临床杂志,2016,23(7):858-860.
[6]丁世美,肖东霖,朱瑞凌,等.经腹腹膜前疝修补术45例临床观察[J/CD].中华疝和腹壁外科杂志(电子版),2015,9(2):151-152.
[7]吴聪.腹壁切口疝采用无张力修补术治疗的临床研究[J].中国医药指南,2016,14(36):157-158.
[8]GONULLU N N,CUBUKCU A,ALPONAT A.Comparison of local and general anesthesia in tension-free Lichtenstein hernioplasty:aprospective randomized trial[J].Hernia,2002,6(1):29-32.
[9]杨帅帅,李海玲,崔景利,等.3D腹腔镜联合杂交技术在腹壁巨大切口疝中的应用体会[J].腹腔镜外科杂志,2016,21(12):929-931.
[10]SANJAY P,WOODWARD A.Local versus general anaesthesia with prolene hernia system mesh for inguinal hernia repair:early and long-term outcomes[J].Dig Surg,2008,25(5):347-350.
[11]院存珍,樊晨.部分可吸收补片无张力修补术治疗腹壁切口疝30例临床观察[J/CD].中华疝和腹壁外科杂志(电子版),2015,9(2):15-16.
[12]GULTEKIN F A,KURUKAHVECIOGLU O,KURU-AHVECIOGLU O,et al.A prospective comparison of local and spinal anesthesia for inguinal hernia repair[J].Hernia,2007,11(2):153-156.
[13]吴华苗,张永年,徐小想.局部神经阻滞麻醉在老年腹股沟疝无张力疝修补术中的临床应用[J/CD].中华疝和腹壁外科杂志(电子版),2015,9(6):519-520.
[14]叶林,王健,周俊强.七氟烷复合舒芬太尼静脉麻醉在小儿腹腔镜疝气修复术中的应用[J].海南医学,2016,12(27):4097-4099.
[15]吴雪峰.腹股沟疝术后疼痛原因及其治疗方法探究[J].中国农村卫生,2016,10(20):8-9.
[16]KINGSNORTH A N,BOWLEY D M,PORTER C.Aprospective study of 1 000hernias:results of the plymouth hernia service[J].Ann R Coll Surg Engl,2003,85(1):18-22.