联合应用布比卡因与地塞米松对经鼻蝶入路手术患者术后镇痛疗效观察.docVIP

联合应用布比卡因与地塞米松对经鼻蝶入路手术患者术后镇痛疗效观察 　　【摘要】 目的：观察地塞米松与布比卡因联合应用于经鼻蝶入路患者术后的镇痛疗效。方法：将120例筛选患者随机数字表法分成两组，对照组接受布比卡因，实验组给予布比卡因加地塞米松。两组患者均接受全身麻醉，诱导麻醉成功后，立即进行双侧局部神经阻滞麻醉。比较两组患者术后疼痛评分和需要止痛剂的量及频次。结果：术后1、2、4、6和12 h，实验组VAS疼痛评分均显著低于对照组（P0.05）。实验组术后需要口服或肌注镇痛剂的患者显著少于对照组（P0.05）。术中或术后24 h未发现相关并发症。结论：布比卡因联合地塞米松可减少经鼻蝶入路手术患者术后的疼痛和对镇痛药的需求，且未发现急性或短期术后并发症。 　　【关键词】 布比卡因； 地塞米松； 鼻蝶入路； 垂体瘤 　　【Abstract】 Objective： To investigate local anesthetic effect of bupivacaine plus dexamethasone in transsphenoidal approach postoperative. Method： 120 patients were randomly divided into two groups， that control group received bupivacaine， and study group was given bupivacaine plus dexamethasone. All the patients received general anesthesia， bilateral local nerve blockade was used in both groups after successful induction of anesthesia. To compare postoperative pain score and the amount and frequency of analgesic requirement in both groups. Result： At 1， 2， 4， 6， and 12 h post surgery， VAS pain values were significantly lower in the study group than those in the control group （P0.05）， but no statistical significance in VAS score between the two groups after 24 h. The analgesic requirement was significantly lower in the study group compared with the control group. No relevant complications were seen during surgery or postoperative hospitalization. Conclusion： The positive effect of the combination of dexamethasone with bupivacaine in reducing pain and the need for analgesic drugs after transsphenoidal approach operative， and no acute or short-term post-surgical complications are observed in this study. 　　【Key words】 Bupivacaine； Dexamethasone； Transsphenoidal approach； Pituitary tumors 　　First-author’s address： Xinxiang Central Hospital， Xinxiang 453000， China 　　doi：10.3969/j.issn.1674-4985.2014.22.024 　　自显微镜应用于神经外科以后，经鼻蝶入路手术已经成为重要入路之一[1]，手术技术已较成熟，但术后患者常并发中到重度疼痛，增加口服止痛药剂量，并可能诱发脑出血、加重脑水肿程度，并同时增加心肌耗氧量，对有基础性心脏病者可能引起心肌缺血与梗死，从而增加围术期死亡率[2]。适当的疼痛控制是患者术后治疗的一个重要的考虑因素，医师应确保治疗过程不增加患者额外或不必要的疼痛。疼痛特别常见于涉及鼻部操作手术后，尤其是当骨操