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中华结直肠疾病电子杂志

中华结直肠疾病电子杂志 ›› 2017, Vol. 06 ›› Issue (05) : 392 -396. doi: 10.3877/cma.j.issn.2095-3224.2017.05.008

所属专题： 文献；

论著

超声引导下阴部神经阻滞用于PPH术后镇痛的效果观察
姜静婧1, 冯璐2, 薛伟力3, 王震4, 刘阳4, 丁文刚2,†()   
  1. 1. 100010　北京协和医院儿内科
    2. 100086　哈尔滨医科大学附属第二医院麻醉科
    3. 100086　哈尔滨医科大学附属第二医院超声科
    4. 100086　哈尔滨医科大学附属第二医院普外科
  • 收稿日期:2017-03-28 出版日期:2017-10-25
  • 通信作者: 丁文刚

Improved technique of ultrasound-guided pudendal nerve block for PPH postoperative pain management

Jingjing Jiang1, Lu Feng2, Weili Xue3, Zhen Wang4, Yang Liu4, Wengang Ding2,†()   

  1. 1. Department of Paediatrics, Peking Union Medical College Hospital
    2. Department of Anesthesiology, The Second Affiliated Hospital of Harbin Medical University, Harbin 100086, China
    3. Department of Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin 100086, China
    4. Department of General Surgury, The Second Affiliated Hospital of Harbin Medical University, Harbin 100086, China
  • Received:2017-03-28 Published:2017-10-25
  • Corresponding author: Wengang Ding
  • About author:
    Corresponding author: Ding Wengang, Email:
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引用本文：

姜静婧, 冯璐, 薛伟力, 王震, 刘阳, 丁文刚. 超声引导下阴部神经阻滞用于PPH术后镇痛的效果观察[J/OL]. 中华结直肠疾病电子杂志, 2017, 06(05): 392-396.

Jingjing Jiang, Lu Feng, Weili Xue, Zhen Wang, Yang Liu, Wengang Ding. Improved technique of ultrasound-guided pudendal nerve block for PPH postoperative pain management[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2017, 06(05): 392-396.

目的

介绍一种改良的超声引导下阴部神经阻滞方法，并比较局部浸润麻醉和超声引导下阴部神经阻滞用于吻合器痔上黏膜环切术术后镇痛效果。

方法

拟在腰麻下行择期PPH术的60例混合痔患者纳入本研究。随机分为超声引导下阴部神经阻滞组（perineum nerve block，PNB组）和局麻镇痛组（local anaesthesia，LA组），每组30例患者。手术结束后，PNB组患者实施超声引导下PNB，双侧分别给予浓度为0.5%的罗哌卡因注射液10 mL；LA组患者实施局部多点麻醉，给予浓度为0.5%的罗哌卡因注射液共20 mL。分别观察比较两组的首次疼痛时间及术后视觉模拟评分，曲马多需求量情况、肛门括约肌痉挛情况、术后恶心呕吐情况及患者满意度情况。

结果

PNB组肛门疼痛评分在术后12 h内各点明显低于LA组（Z=-5.909，P< 0.001）。且PNB组较LA组第一次感到肛门痛时间延后（t=10.502，P<0.0001）、术后对曲马多的使用量趋势降低（Χ2=4.022，P< 0.05），肛门括约肌痉挛情况减少（Χ2=2.390，P<0.05），患者对该方法的满意程度增加（Χ2=8.531，P<0.05），而患者PONV情况则差异无统计学意义（Χ2=0，P>0.05）。

结论

混合痔外剥内扎切除术后使用阴部神经阻滞镇痛短期效果良好，尿潴留发生率明显降低。

关键词: 痔, PPH, 镇痛, 超声引导下阴部神经阻滞
Objective

The aim of this randomized and double-blind study was to introduce and examine the clinical utility of an improved ultrasound-guided pudendal nerve block technique, and compare the effective of two different postoperative analgesia techniques, local infiltration analgesia and pudendal nerve block for PPH operation.

Methods

A total of 60 patients with mixed hemorrhoid were divided into ultrasound-guided pudendal nerve block group (Group PNB) and local infiltration analgesia group (Group LA) with 30 patients each. Group PNB received ultrasound-guided PNB after the surgery: 0.5% ropivacaine 10 mL each side and 0.5% ropivacaine 20 mL for Group LA. The postoperative analgesia effect measured by Median VAS pain scores. The Analgesia requirements, nausea and vomiting, spasm of anal sphincter during the first 48 postoperative hours and the satisfaction of the patients were also recorded. Ultrasound-guided assessment was confirmed by the anatomical structure and the local anesthetic expanding.

Result

There was a significant reduction in the analgesia duration and the tramadol consumption in Group PNB compared with Group LA. The median VAS within the first 12 hours in PNB group was much lower (Z=-5.909, P< 0.001). The spasm of anal sphincter in Group PNB was less than Group LA in 48 hours after operation (t=10.502, P<0.0001); the satisfaction of the patients was higher in Group PNB (Χ2=8.531, P<0.05).

Conclusion

Ultrasound-guided PNB could provide good postoperative analgesia for PPH, and decrease the rate of urinary retention.

Key words: Hemorrhoid, PPH, Analgesia, Ultrasound Pudendal nerve block
表1 患者基本情况
组别 年龄（岁） 身高（m） 体重（kg） BMI（kg/m2） 性别（男/女）
PNB 44.2±8.8 1.60±0.1 66.2±5.8 24.0±1.2 16/14
LA 44.1±9.4 1.65±0.1 67.2±7.6 24.4±1.3 14/16
检验值 t=-0.028 t=-0.353 t=0.609 t=1.274 Χ2=0.267
P值 0.978 0.726 0.545 0.208 0.606
表2 术后首次疼痛时间（±s）
组别 首次疼痛时间（h）
PNB 10.5±2.2
LA 5.6±1.2
t值 10.502
P值 <0.0001
表3 术后各时间点患者静息时VAS评分
组别 术后6 h 术后12 h 术后18 h 术后24 h 术后48 h
PNB 1.0（2.0） 3.0（3.0） 3.0（3.0） 1.0（2.0） 0.0（1.0）
LA 4.0（1.0） 5.0（2.0） 4.0（1.0） 1.0（1.0） 0.0（1.0）
Z值 -5.612 -5.909 -1.628 -0.190 -1.220
P值 <0.001 <0.001 0.104 0.849 0.222
表4 患者术后恶心、呕吐等不良反应及患者满意度
组别 曲马多（有/无） 恶心呕吐（有/无） 括约肌痉挛（有/无） 满意（是/否）
PNB组 5/25 5/25 5/25 27/3
LA组 12/18 9/21 13/17 20/10
Χ2值 4.022 1.491 5.079 4.812
P值 0.045 0.222 0.024 0.028
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