劉碩慧 范天仁 田劉軍 張偉杰 柴洪艷

骶神經(jīng)阻滯復(fù)合全麻行陰道前后壁修補(bǔ)術(shù)后疼痛評(píng)估

劉碩慧 范天仁 田劉軍 張偉杰 柴洪艷

目的對(duì)骶神經(jīng)阻滯復(fù)合全身麻醉(全麻)用于陰道前后壁修補(bǔ)術(shù)患者術(shù)后疼痛進(jìn)行及時(shí)評(píng)估并干預(yù)。方法60例60～65歲需行陰道前后壁修補(bǔ)術(shù)的患者,隨機(jī)分為對(duì)照組(C組)和研究組(R組)。C組麻醉方式采用單純?nèi)椴骞?R組用骶神經(jīng)阻滯復(fù)合全麻插管。對(duì)兩組患者術(shù)后1、2、6、12、24 h (T1、T2、T3、T4、T5)進(jìn)行疼痛治療,疼痛爆發(fā)時(shí)采用視覺(jué)模擬評(píng)分法(VAS)進(jìn)行評(píng)估。結(jié)果研究組較對(duì)照組患者術(shù)后24 h鎮(zhèn)痛效果好,研究組T1、T2、T3、T4 VAS評(píng)分與對(duì)照組比較,差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)。24 h后(T5)患者疼痛減輕(P＞0.05)。對(duì)照組24 h內(nèi)出現(xiàn)爆發(fā)痛人數(shù)較研究組比較,差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)。結(jié)論陰道前后壁術(shù)后患者的及時(shí)疼痛評(píng)估能指導(dǎo)醫(yī)師對(duì)患者術(shù)后疼痛進(jìn)行合理治療。

骶神經(jīng)阻滯；全身麻醉；陰道前后壁修補(bǔ)術(shù)；疼痛評(píng)估

陰道前后壁修補(bǔ)術(shù)麻醉方式多采用氣管插管加肌肉松弛劑施行控制呼吸,有利于保證適當(dāng)?shù)穆樽砩疃群途S持有效的通氣避免膈肌運(yùn)動(dòng),使陰道肌肉松弛,有利于術(shù)者操作,極大提高患者的舒適度和安全性,技術(shù)操作更方便和快捷,但術(shù)后會(huì)陰疼痛不能很好解決,影響患者下床活動(dòng)。骶神經(jīng)阻滯能夠提供術(shù)后鎮(zhèn)痛且增加陰道肌肉的松弛,能阻斷手術(shù)區(qū)域大多數(shù)的交感神經(jīng)沖動(dòng)傳導(dǎo)使疼痛的主要傳入途徑被阻斷,大大減弱疼痛刺激傳入量,單次用藥就能達(dá)到術(shù)中要求的肌松及術(shù)后無(wú)痛。

1 資料與方法

1.1 一般資料 選取2015年1月～2016年1月本院收治的60例年齡60～65歲需行陰道前后壁修補(bǔ)術(shù)的患者,隨機(jī)分為對(duì)照組(C組)和研究組(R組),各30例。

1.2 方法 C組麻醉方式采用單純?nèi)椴骞?R組用骶神經(jīng)阻滯復(fù)合全麻插管。由一名醫(yī)務(wù)人員用VAS于術(shù)后1、2、6、12、24 h(T1、T2、T3、T4、T5)評(píng)估患者術(shù)后疼痛情況,記錄患者VAS≥7分的數(shù)量,出現(xiàn)爆發(fā)痛時(shí)隨時(shí)評(píng)估記錄。根據(jù)疼痛結(jié)果進(jìn)行鎮(zhèn)痛藥物治療。

1.3 統(tǒng)計(jì)學(xué)方法 采用SPSS11.5統(tǒng)計(jì)學(xué)軟件進(jìn)行統(tǒng)計(jì)分析。計(jì)量資料以均數(shù)±標(biāo)準(zhǔn)差(±s)表示,采用t檢驗(yàn)；計(jì)數(shù)資料以率(%)表示,采用χ2檢驗(yàn)。P＜0.05表示差異具有統(tǒng)計(jì)學(xué)意義。

2 結(jié)果

研究組較對(duì)照組患者術(shù)后24 h鎮(zhèn)痛效果好,研究組T1、T2、T3、T4 VAS評(píng)分與對(duì)照組比較,差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)。24 h后(T5)患者疼痛減輕,兩組比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P＞0.05)。見(jiàn)表1。對(duì)照組24 h內(nèi)出現(xiàn)爆發(fā)痛人數(shù)(6例)較研究組(1例)比較,差異有統(tǒng)計(jì)學(xué)意義(P＜0.05)。

表1 兩組患者不同時(shí)間VAS分比較(±s)

表1 兩組患者不同時(shí)間VAS分比較(±s)

注：與對(duì)照組比較,aP＜0.05,bP＞0.05

組別 例數(shù) T1 T2 T3 T4 T5研究組 30 1.1±0.4a 1.8±1.3a 2.1±1.4a 2.2±1.1a 8.2±1.7b對(duì)照組 30 17.1±1.2 10.1±1.3 20.9±1.4 23.9±1.4 8.5±1.1P＜0.05 ＜0.05 ＜0.05 ＜0.05 ＞0.05

3 小結(jié)

骶神經(jīng)阻滯復(fù)合全麻為陰道前后壁修補(bǔ)術(shù)提供了一種安全方便,有效無(wú)痛的麻醉方法［1］。手術(shù)后正確的疼痛評(píng)估及進(jìn)行及時(shí)的疼痛治療對(duì)于患者身體的恢復(fù)起積極的作用,且對(duì)患者減少心理創(chuàng)傷。研究發(fā)現(xiàn)術(shù)前、術(shù)中、術(shù)后均對(duì)傷害性感受加以阻滯可能會(huì)達(dá)到完全無(wú)痛的結(jié)果［2］。研究組在術(shù)前進(jìn)行了骶神經(jīng)阻滯,術(shù)后對(duì)研究組患者的疼痛評(píng)估顯示了良好的鎮(zhèn)痛作用,此種鎮(zhèn)痛方式值得臨床推廣。

［1］范天仁,田劉軍,郭暉.骶神經(jīng)阻滯復(fù)合全麻在陰道前后壁修補(bǔ)術(shù)中比較觀察.醫(yī)學(xué)與哲學(xué)：b,2013,34(9):33-34.

［2］Woolf CJ,Chong MS.Preemptive analgesia-treating post-operative pain by preventing the establishment of central sensitization.Anesth Analg,1993,77(22):362-379.

Pain assessment after anterior and posterior colporrhaphy under sacral nerve block combined with general anesthesia

LIU Shuo-hui,FAN Tian-ren,TIAN Liu-jun,et al.Department of Pain,Weifang City People’s Hospital,Weifang 261041,China

ObjectiveTo assess and intervene pain after anterior and posterior colporrhaphy under sacral nerve block combined with general anesthesia.MethodsA total of 60 patients aging 60～65 years old and receiving anterior and posterior colporrhaphy were randomly divided into control group (group C) and research group (group R),with 30 cases in each group.Group C received general anesthesia alone,and group R received sacral nerve block combined with general anesthesia.Pain treatment was made on postoperative 1,2,6,12,24 h (T1,T2,T3,T4,T5) status in both groups,and evaluation was made by visual analogue scale (VAS) during outbreak of pain.ResultsThe research group had better postoperative 24 h analgesic effect than the control group,and the differences of VAS scores in T1,T2,T3 and T4 all had statistical significance between the two groups (P＜0.05).Pain was relieved after 24 h (T5) (P＞0.05).The difference of cases with breakthrough pain in 24 h between the control group and the research group had statistical significance (P＜0.05).ConclusionTimely pain assessment for patients after anterior and posterior colporrhaphy provides guideline for rational treatment of postoperative pain.

Sacral nerve block; General anesthesia; Anterior and posterior colporrhaphy; Pain assessment

10.14164/j.cnki.cn11-5581/r.2016.14.189

2016-04-14］

261041 濰坊市人民醫(yī)院疼痛科

柴洪艷