丁卡因凝膠肛內表麻聯合在PPH術后鎮痛中的應用

吳耀輝

【摘要】 目的：探討本院自制丁卡因凝膠肛內表麻在PPH術后鎮痛及并發癥控制的可行性及有效性。方法：選擇2016年8月-2017年7月在本院進行PPH手術的患者共100例，患者均在低濃度布比卡因腰麻下完成手術，其中50例術后留置硬膜外導管，接鎮痛泵行硬膜外鎮痛作為對照組。另外50例術后以涂有丁卡因凝膠的紗塊填塞肛內壓迫止血作為試驗組。比較兩組術后4、8、12、24、36 h的視覺模擬評分（VAS），術后排尿情況和術后并發癥情況。結果：兩組術后4、8、12、24、36 h的VAS評分均逐步降低，兩組術后VAS評分比較，差異均無統計學意義（P>0.05）。試驗組術后僅發生尿潴留5例，心悸2例，惡心1例，術后并發癥發生率12%，對照組術后發生尿潴留44例，其他并發癥16例，術后并發癥發生率92%，兩組術后并發癥發生率比較，差異有統計學意義（P<0.05）。術后兩組鎮痛效果滿意度分別為試驗組98%，對照組96%，兩組比較差異有統計學意義（P<0.05）。試驗組術后鎮痛便捷度及鎮痛費用滿意度均為100%，均顯著高于對照組的86%、76%，兩組比較差異均有統計學意義（P<0.05）。結論：丁卡因凝膠肛內表麻鎮痛是一種簡單、有效、經濟的PPH術后鎮痛方法，能夠明顯減輕術后患者的痛苦，大大降低并發癥的發生，減輕患者負擔，提高醫療滿意度。

【關鍵詞】 丁卡因凝膠； 吻合器痔上黏膜環切術； 鎮痛； 并發癥

【Abstract】 Objective：To investigate the effect of tetracaine gel on postoperative analgesia and complications in PPH patients.Method：100 patients with PPH surgery in our hospital from August 2016 to July 2017 were selected.They were operated under low concentrations of bupivacaine and spinal anesthesia，50 cases of epidural catheter was placed postoperatively and analgesic pump was used to relieve epidural analgesia as control group，and 50 patients were treated with gauze filled with tetracaine gel to inner anus compression hemostasis as experimental group.4，8，12，24 and 36 h of postoperative visual analogue score（VAS），postoperative complications and postoperative urination were compared between two groups.Result：The postoperative VAS scores of 4，8，12，24 and 36 h in two groups were decreased gradually，the postoperative VAS scores of two groups were compared，the differences were not statistically significant（P>0.05）.The postoperative complication rate of the experimental group was 12%，included 5 cases of urinary retention，2 cases of palpitation，1 case of nausea，the postoperative complication rate of the control group was 92%，included 44 cases of urinary retention occurred and 16 cases of others，the postoperative complication rate of two groups were compared，the difference was statistically significant（P<0.05）.The satisfaction of analgesic effect of the experimental group was 98% and the control group was 96%，the difference was not statistically significant between two groups（P<0.05）.The satisfaction degree of postoperative analgesia convenience and analgesia cost of the experimental group were 100%，which were significantly higher than 86% and 76% of the control group，the differences were statistically significant（P<0.05）.Conclusion：Tetracaine gel anal anesthesia is a simple，effective and economical method of postoperative analgesia for PPH.It can obviously reduce the pain of the patients，the occurrence of complications and the burden of patients and improve the satisfaction degree of the medical treatment.endprint

【Key words】 Tetracaine gel； PPH； Analgesia； Complication

First-authors address：Lunjiao Hospital in Shunde District of Foshan，Foshan 528303，China

doi：10.3969/j.issn.1674-4985.2017.29.025

傳統手術治療痔病以切除病變為主，這種治療方法較為復雜且并發癥較多，同時具有一定的復發性[1-2]。但是隨著近代醫學的發展，吻合器痔上黏膜環切術（procedure for prolapse and hemorrhoids，PPH）逐步取代傳統手術方法，成為目前臨床公認且廣泛應用的一種治療Ⅲ～Ⅳ度內痔及混合痔的手術方法[3-4]。PPH屬于一種微創術，其手術過程短、操作簡單，同時相對傳統手術來說術后創傷恢復快、患者疼痛較少，但是由于PPH依舊會觸及患者肛門神經，術后依舊會有疼痛及相關并發癥的發生，因此為了減緩患者的疼痛，國內PPH術后鎮痛大多采用硬膜外鎮痛[5]，雖然鎮痛效果好，但尿潴留等并發癥發生率高[6-7]，患者大多需要留置尿管。此外……