目的 探討圍手術期超前平衡鎮痛在肛腸手術中止痛的臨床效果。方法 回顧性分析2009年11月至2010年10月期間巴中市中醫院肛腸科123例采用腰俞穴麻醉的肛腸手術患者的臨床資料，患者被分成超前平衡鎮痛組（60例）和傳統鎮痛組（63例）2組。2組術前準備相同，術后均口服布洛芬緩釋膠囊300mg止痛，2次/d。對Ⅲ～Ⅳ度內痔及內括約肌痙攣的患者術中均常規行內括約肌松解術，對VAS評分6分以上的患者選擇使用鹽酸曲馬多注射止痛。超前平衡鎮痛組術前0.5h肌注安定10mg，口服布洛芬緩釋膠囊300mg，術中采用2%鹽酸利多卡因5ml、0.75%鹽酸布比卡因5ml、芬太尼50 μg、地塞米松5mg用生理鹽水稀釋成20ml行腰俞穴麻醉并止痛，術畢肛內塞用雙氯芬酸鈉栓1枚。傳統鎮痛組術中采用2%鹽酸利多卡因5ml、0.75%鹽酸布比卡因5ml用生理鹽水稀釋成20ml行腰俞穴麻醉。比較2組術后4、6、8、12、24及48 h VAS評分、鹽酸曲馬多使用率及惡心、嘔吐及尿潴留的發生率。結果 術后4、6、8、12、24及48 h VAS評分超前平衡鎮痛組均明顯低于傳統鎮痛組（P＜0.01），術后鹽酸曲馬多使用率超前平衡鎮痛組明顯低于傳統鎮痛組（P＜0.05），惡心、嘔吐及尿潴留的發生率2組比較差異均無統計學意義（P＞0.05）。結論 圍手術期超前平衡鎮痛用于肛腸手術止痛是一種療效肯定、安全、不良反應少而又簡單易行的鎮痛方法。
ObjectiveTo investigate the clinical effect and the incidence of postoperative complications of Milligan-Morgan hemorrhoids combined with reducing tension of alary incision in the treatment of annular mixed hemorrhoids.MethodsProspectively collected 120 patients with annular mixed hemorrhoids who received treatment from the Department of Colorectal Surgery of Bazhong Hospital of Traditional Chinese Medicinel during the April, 2016 to October, 2018. All of the 120 patients with annular mixed hemorrhoids were randomly divided into the experimental group and the control group, with 60 patients in each one group. Patients in the experimental group was treated with Milligan-Morgan hemorrhoids combined with reducing tension of alary incision, while patients in the control group with conventional Milligan-Morgan hemorrhoid.ResultsIn the experimental group, 49 cases were cured, 11 cases showed obvious effect; in the control group, 39 cases were cured, 20 cases showed obvious effect, and 1 case was effective. The curative effect in experimental groups was better than that of the control group (Z=–2.090, P=0.037), and the effective rates of these two group were both 100% in total. The mean healing time was (19±3) d (14–21 d) in the experimental group and (21±3) d (14–24 d) in the control group, respectively, which was better in the experimental group (Z=–13.636, P<0.001). Experimental group with lower score of wound pain, hemafecia, and anal margin edema, which were much better than control group on 1 d and 3 d after operation (P<0.05). There was no statistically significant differences on incidence of uroschesis and recurrence rate between the two groups (P>0.05).ConclusionsMilligan-Morgan hemorrhoids combined with reducing tension of alary incision in the treatment of annular mixed hemorrhoids has good clinical effect and deserves clinical application.
