The Effects Of Preemptive Analgesia On Postoperative Analgesia And Stress Response Of The Patients With Hepatolith

BackgroundHepatolith is a common disease in China,it mainly distributed in the southwest and south of China,Hunan province is also a high incidence area.Complicated hepatolith distribution in multiple hepatic segments,Causing the liver tissue fibrosis,bile duct stricture and the change of liver anatomical structure,even becoming atrophy-hypertrophy complex.Most patients with complicated hepatolith need laparotomy surgery,but laparotomy surgery has the problems of large surgical trauma,long incision and postoperatin pain.Enhanced recovery after surgery are a series of optimized perioperative management measures on the basis of evidence-based throughout the preoperative,to reduce the postoperative complications and accelerate rehabilitation.Accelerate rehabilitation surgery experts at home and abroad proposed that perioperative multimodal analgesia scheme should be adopted to reduce the dosage of analgesic drugs and achieve the best effect.Advanced analgesia is one of the most important aspects of the multimodal analgesia,there should be further research on the advance analgesic used in the treatment of hepatolith to prove whether benefit patients.ObjectiveTo explore the analgesia effect of preemptive analgesia for postoperative patients with hepatolith and the influence of body’s stress response,evaluate the effect and safty of preemptive analgesic,and provide theory basis for the application of analgesia in the liver and gallbladder surgery.MethodsWe selected a total of 84 patients with hepatolith that should operated by open type gallbladder excision,left lobe resection and biliary tract exploration from May 2015 to December 2016.We randomly divided the 84 patients into trial group and control group.The trial group use flurbiprofen axetil injection(0.9% NS 100 ml with flurbiprofen axetil 100 mg)30 minutes before operation,the control group use 100 ml 0.9% NS at the same time.The two groups of patients with postoperative all use the same ingredient of self-control intravenous analgesia pump(PCIA).Compare the operation time,intra-operative blood loss,Postoperative 4h,8h,12 h,24h,48 h,72h’s visual analogue scale(VAS),postoperative PCIA press number,Postoperative complication,Postoperative usage of pethidine hydrochloride,concentration of C reactive protein after 12 h,24 h,48 h,72 h,Blood glucose change after 6 h,12 h,24 h and 36 h,48 h,the postoperative complications.ResultsThere were 79 patients completed test finally,there are 40 patients in treatment group,there are 39 patients in control group.VAS scores of each time point after 24 h of experimental group were lower than that of control group(P < 0.05),there was no significant difference in the VAS of 48 h and 72h(P > 0.05).the postoperative PCIA press number in 1-24 h and 24-48 h of treatment group was lower than the control group(P < 0.05).The postoperative complications have no statistical difference between two groups(P > 0.05).Preemptive analgesia group pethidine hydrochloride utilization rate was lower than those of control group,but have no statistical difference(P >0.05).The concentration of C reactive protein in postoperative 48 h of experimental group was lower than control group(P<0.05),but have no significant difference in 72h(P>0.05).The blood glucose of experimental group at 6h,12 h,and 24 h are lower than the control group(P < 0.05),but have no significant difference in 36 h and 48h(P>0.05).The postoperative complications of two groups have no significant difference(P > 0.05).ConclusionPreemptive analgesic used in the treatment of patients with hepatolith can relieve pain and stress reaction of postoperative.Preemptive analgesic didn’t increase the incidence of postoperative side effects and complications.It has good safety and effectiveness,and is worthy in clinical apply.