目的比較達芬奇機器人與胸腔鏡輔助小切口手術對患者術后疼痛的影響。方法回顧性分析我科2015年1～4月手術治療的肺部和縱隔腫瘤患者88例的臨床資料。按手術方式將患者分為機器人組[（49例，男23例、女26例，年齡（55.14±13.03）歲]和胸腔鏡組[39例，男23例、女16例，年齡（56.92±8.98）歲]，比較兩組患者術后疼痛情況。結果與胸腔鏡組比較，機器人組手術時間（t=-2.298，P=0.024）和胸腔引流時間（t=-2.421，P=0.018）更短，且差異有統計學意義。與胸腔鏡組比較，機器人組術后24 h 視覺模擬（VAS）評分更低，差異也有統計學意義（1.00±0.74 vs.2.33±1.64，t=-4.704，P=0.000）。兩組術后48 h VAS 評分差異則無統計學意義（t=-0.244，P=0.808）。結論與胸腔鏡手術相比，達芬奇機器人手術系統治療肺部及縱隔腫瘤，具有手術更安全、手術時間短、術后胸腔引流時間短、疼痛輕、更微創等優勢。
【摘要】 目的 評估羅哌卡因切口預注射聯合曲馬多對腹腔鏡下膽囊切除術（laparoscopic cholecystectomy，LC）術后疼痛的影響。 方法 選取2010年6月-2011年4月行擇期LC患者120例，年齡18~65歲，美國麻醉師協會Ⅰ~Ⅱ級，采用完全隨機的設計分組：0.75%羅哌卡因10 mL切口注射+術畢靜脈注射曲馬多（2 mg/kg）組（A組，n=30）；生理鹽水10 mL切口注射+術畢靜脈注射曲馬多（2 mg/kg）組（B組，n=30）；0.75%羅哌卡因10 mL切口注射+術畢靜脈注射生理鹽水10 mL組（C組，n=30）；生理鹽水組（D組，n=30）。術后2、4、6、12、24 h分別評估右上腹部、右肩背部和腹壁切口疼痛進行視覺模擬評分（visual analog scale，VAS）。 結果 右上腹部及右肩背部疼痛VAS比較：與D組相比，A、B組VAS評分明顯減少（Plt;0.05），而C組無明顯統計學差異（Pgt;0.05）；B組與A組相比，2~24 h VAS評分明顯增加（Plt;0.05）；C組與A組相比，2~24 h VAS評分增高（Plt;0.01）。腹壁切口疼痛VAS比較:與D組相比，A、B、C組VAS評分明顯減少（Plt;0.05）；B組與A組相比，2~24 h VAS評分明顯增加（Plt;0.05）；C組與A組相比，2~24 h VAS評分顯著增高（Plt;0.01）。 結論 腹腔鏡膽囊切除術術前切口羅哌卡因預注射-術畢曲馬多靜脈注射對減輕術后疼痛有良好效果。【Abstract】 Objective To evaluate the effects of preincisional ropivacaine plus tramadol intravenous injection on postoperative pain relief after laparoscopic cholecystectomy (LC). Methods One hundred and twenty patients aged between 18 and 65 years old with an ASA score from Ⅰ to Ⅱ who underwent elective laparoscopic cholecystectomy from June 2010 to April 2011 comprised this study. The patients were randomly divided into four groups with 30 in each group. Patients in group A had an infusion of 0.75% ropivacaine (10 mL) at the beginning of LC plus tramadol (2 mg/kg) intravenous injection at the end. Group B patients had an infusion of normal saline 0.9% (10 mL) at the beginning of LC plus tramadol (2 mg/kg) intravenous injection at the end. Patients in group C had an infusion of 0.75% ropivacaine (10 mL) at the beginning of LC plus normal saline 0.9% (10 mL) intravenous injection at the end. Group D (control group) patients had neither ropivacaine nor tramadol infusion. Pain in the right upper abdomen, right shoulder tip and abdominal incision were assessed at hour 2, 4, 6, 12, and 24 postoperatively using a visual analog score (VAS). Results Right upper abdomen and right shoulder tip pain VAS comparison: significantly lower pain scores were observed in group A and B (Plt;0.05) than in group D (Pgt;0.05). Group A had significantly lower pain scores than group B (Plt;0.05) and C (Plt;0.01) at postoperative hours 2, 4, 6, 12, and 24. Abdominal incision pain VAS comparison: VAS scores were significantly lower in group A, B and C than in group D (Plt;0.05). Group A had significantly lower pain scores than group B (Plt;0.05) and C (Plt;0.01) at postoperative hours 2, 4, 6, 12, and 24. Conclusion Preincisional ropivacaine at the beginning of LC combined with tramadol intravenous injection at the end can effectively alleviate postoperative pain after laparoscopic cholecystectomy.
【摘要】 目的 評價撫觸對硬膜外麻醉穿刺疼痛的影響及效果。 方法 2009年1-12月，將485例行硬膜外麻醉穿刺患者隨機分為撫觸組（術中行撫觸干預）和對照組（常規護理），觀察兩組患者的穿刺程度、穿刺時間。 結果 撫觸組患者疼痛程度、穿刺時間較對照組有明顯改善，且差異有統計學意義（Plt;0.01）。 結論 撫觸可降低應激引起的硬膜外麻醉穿刺患者的疼痛程度，保持穿刺體位從而縮短穿刺時間，有利于麻醉操作順利進行。【Abstract】 Objective To evaluate the effect of touching on alleviating the pain in patients undergoing epidural anesthesia puncture. Methods A total of 485 patients who underwent epidural puncture from January to December 2009 were randomly divided into two groups: 259 in touching group and 226 in control group. In the touching group, the patients were touched and consoled while undergoing epidural puncture. The pain extent and time of puncture were observed and recorded. Results The level of pain and time of puncture were obviously alleviated and shortened in the touching group and the difference between the two groups was statistically significant. Conclusion Touching could reduce the stress and pain caused by epidural puncture, which may lead to maintain the puncture position and thereby shorten the puncture time. It helps to finish the narcotic operation favorably.
