腹腔镜胆囊切除术与妇科腹腔镜手术中舒芬太尼-曲马多自控静脉镇痛的比较

[Comparison of sufentanil-tramadol PCIA between laparoscopic cholecystectomy and gynecological laparoscopy].

作者信息

Guo Shanna, Duan Guangyou, Wang Jintao, Chi Xiaohui, Zhang Li, Zhang Xianwei

机构信息

Department of Anesthesiology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.

Department of Anesthesiology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China. Email:

出版信息

Zhonghua Wai Ke Za Zhi. 2015 Feb;53(2):150-4.

PMID:25908291

Abstract

OBJECTIVE

To compare the differences of postoperative patient-controlled intravenous analgesia for laparoscopic cholecystectomy and gynecological laparoscopy in female patients.

METHODS

This retrospective study included 645 female patients received laparoscopic cholecystectomy or gynecological laparoscopy (laparoscopic oophorocystectomy/myomectomy) between January 2011 and July 2012 in Tongji Hospital. Among them, 207 cases of sufentanil-tramadol patient-controlled intravenous analgesia (PCIA) were enrolled and divided into 2 groups:77 cases in laparoscopic cholecystectomy group, and 130 cases in gynecological laparoscopy group. The pressing frequency and consumption of PCIA, localization and quality of postoperative pain, visual analogue scale (VAS) at 4-6 h, 8-12 h, 18-24 h after surgery, and adverse effect were compared by t-test,χ(2) test, Fisher exact test or Mann-Whitney test.

RESULTS

There was no statistical difference of age, body mass index, and operation time between the two groups (all P > 0.05). As compared with the gynecological laparoscopy group (3 (4)), PCIA pressing frequency was higher in the laparoscopic cholecystectomy group (5 (7)), but there was no statistical difference (Z = -1.747, P = 0.081). PCIA consumption in the laparoscopic cholecystectomy group (79 (33) ml) was higher than that in the gynecological laparoscopy group (48 (30) ml) (Z = -6.267, P = 0.000). The postoperative pain localization and quality were different in the two groups, the patients in the laparoscopic cholecystectomy group experienced dull pain in lower abdomen, but the ones in the gynecological laparoscopy group had distending pain in upper abdomen and piercing pain around scapula. The differences of 4-6 h, 8-12 h, 18-24 h VAS scores in the two groups had no statistical significance (all P > 0.05). The total incidence of postoperative adverse effect between the two groups had no statistical significant difference (laparoscopic cholecystectomy group:11.7%, gynecological laparoscopy group:16.2%) (χ(2) = 0.778, P = 0.378). The incidence of dizziness was higher in the gynecological laparoscopy group (6.2%) than that in the laparoscopic cholecystectomy group (0) (Fisher exact test:P < 0.05).

CONCLUSION

In the case of sufentanil-tramadol PCIA, laparoscopic cholecystectomy needs more postoperative analgesia, while gynecological laparoscopy has higher incidence of dizziness.

摘要

目的

比较女性患者腹腔镜胆囊切除术和妇科腹腔镜手术后患者自控静脉镇痛的差异。

方法

本回顾性研究纳入了2011年1月至2012年7月在同济医院接受腹腔镜胆囊切除术或妇科腹腔镜手术（腹腔镜卵巢囊肿切除术/子宫肌瘤切除术）的645例女性患者。其中，207例接受舒芬太尼-曲马多患者自控静脉镇痛（PCIA）的患者被纳入并分为2组：腹腔镜胆囊切除术组77例，妇科腹腔镜手术组130例。通过t检验、χ²检验、Fisher确切概率法或Mann-Whitney检验比较PCIA的按压频率和用量、术后疼痛的部位和性质、术后4-6小时、8-12小时、18-24小时的视觉模拟评分（VAS）以及不良反应。

结果

两组患者的年龄、体重指数和手术时间差异均无统计学意义（均P>0.05）。与妇科腹腔镜手术组（3（4））相比，腹腔镜胆囊切除术组的PCIA按压频率更高（5（7）），但差异无统计学意义（Z=-1.747，P=0.081）。腹腔镜胆囊切除术组的PCIA用量（79（33）ml）高于妇科腹腔镜手术组（48（30）ml）（Z=-6.267，P=0.000）。两组术后疼痛的部位和性质不同，腹腔镜胆囊切除术组患者下腹部为隐痛，而妇科腹腔镜手术组患者上腹部为胀痛、肩胛周围为刺痛。两组术后4-6小时、8-12小时、18-24小时VAS评分差异均无统计学意义（均P>0.05）。两组术后不良反应总发生率差异无统计学意义（腹腔镜胆囊切除术组：11.7%，妇科腹腔镜手术组：16.2%）（χ²=0.778，P=0.378）。妇科腹腔镜手术组头晕发生率（6.2%）高于腹腔镜胆囊切除术组（0）（Fisher确切概率法：P<0.05）。