亚甲蓝与布比卡因脂质体溶液对混合痔术后疗效对比分析

Methylene Blue vs. Liposomal Bupivacaine: Postoperative Outcomes in Mixed Hemorrhoids Surgery

摘要: 目的：探究亚甲蓝溶液和布比卡因脂质体注射液在混合痔外剥内扎术后患者镇痛治疗效果。方法：选取2023年12月至2025年2月在本院收治的混合痔患者190例，均完善其心电图，胸部X线，血常规等术前检查，检查结果均无异常，均对其进行混合痔的外剥内扎外科手术治疗，根据镇痛药物差异分组为观察组和对照组各95例。观察组采用布比卡因脂质体注射液15ml进行肛周局部注射镇痛，对照组采用亚甲蓝溶液5 ml混合10 ml生理盐水进行肛周局部镇痛注射，比较两组患者术后第6 h、12 h的疼痛评分、舒适度评分以及术后是否应用双氯芬酸钠利多卡因注射液肌注，术后第1天和第2天创面水肿程度评分及水肿消退时间，术后尿潴留发生率以及术后第1天及第3天创面渗液评分。结果：观察组患者术后6 h、12 h的疼痛评分、术后双氯芬酸钠利多卡因的应用，均低于对照组患者(P < 0.05)具有统计学意义。观察组术后6 h、12 h舒适度高于对照组(P < 0.05)具有统计学意义。观察组患者术后第1天、第2天创面水肿程度评分和水肿消退时间，术后尿潴留发生率均低于对照组(P < 0.05)具有统计学意义。观察组术后第3天创面渗液评分低于对照组(P < 0.05)具有统计学意义。结论：布比卡因脂质体注射液对比亚甲蓝溶液，能更有效降低患者术后疼痛感，减少止疼药物的应用，降低尿潴留发生率，减轻创面渗液，提高患者术后舒适度，更适用于临床的推广与应用。

Abstract: Objective: This paper aims to compare the analgesic effects of methylene blue solution and bupivacaine liposome injection in patients undergoing mixed hemorrhoid surgery with external excision and internal ligation. Methods: A total of 190 patients with mixed hemorrhoids admitted to our hospital from December 2023 to February 2025 were enrolled. All patients completed preoperative examinations including electrocardiogram, chest X-ray, and routine blood tests, with normal results. All underwent external excision and internal ligation surgery. Based on different analgesic agents, they were divided into an Observation group (n = 95) receiving perianal local injection of 15 ml bupivacaine liposome injection, and a Control group (n = 95) receiving perianal local injection of 5 ml methylene blue solution mixed with 10 ml normal saline. Postoperative outcomes compared included: Pain scores (using Visual Analogue Scale, VAS) at 6 h and 12 h postoperatively; Comfort scores at 6 h and 12 h postoperatively; Requirement for intramuscular diclofenac sodium and lidocaine injection; Wound edema scores on postoperative day (POD) 1 and 2, and time for edema resolution; Incidence of urinary retention; Wound exudation scores on POD 1 and 3. Results: Patients in the Observation group demonstrated significantly lower pain scores at 6h and 12h postoperatively, and a reduced requirement for diclofenac sodium and lidocaine injection compared to the Control group (P < 0.05). Comfort scores at 6h and 12h postoperatively were significantly higher in the Observation group (P < 0.05). Wound edema scores on POD 1 and POD 2, time for edema resolution, and the incidence of urinary retention were significantly lower in the Observation group (P < 0.05). The wound exudation score on POD 3 was also significantly lower in the Observation group (P < 0.05). Conclusion: Bupivacaine liposome injection is more effective than methylene blue solution in reducing postoperative pain, decreasing the application of analgesic drugs, lowering the incidence of urinary retention, alleviating wound exudation, and enhancing patient postoperative comfort, making it more suitable for clinical promotion and application.